Which pregnancy-related complication is this patient at greatest risk for: Abruptio placentae, Intraamniotic (intra-amniotic) infection, Postpartum hemorrhage, Preeclampsia with severe features, or Preterm labor?

From the Guidelines

This patient is at greatest risk for preeclampsia with severe features, as it is a significant pregnancy-related complication that can lead to severe morbidity and mortality if not promptly diagnosed and managed. The risk factors for preeclampsia include a history of eclampsia or preeclampsia, previous adverse pregnancy outcome, maternal comorbid conditions such as chronic hypertension, renal disease, and autoimmune diseases, multifetal gestation, nulliparity, obesity, African American race, low socioeconomic status, and advanced maternal age 1.

According to the American Association for the Study of Liver Diseases, preeclampsia affects 3%-8% of pregnancies and may be diagnosed in patients with preexisting hypertension if additional findings of worsening blood pressures, maternal organ dysfunction, or proteinuria are present 1. Preeclampsia with severe features involves extreme elevations in systemic blood pressure and organ compromise, and delivery is recommended at 34 weeks for patients with this condition.

Key factors that increase the risk of preeclampsia with severe features include:

• History of eclampsia or preeclampsia
• Previous adverse pregnancy outcome
• Maternal comorbid conditions such as chronic hypertension, renal disease, and autoimmune diseases
• Multifetal gestation
• Nulliparity
• Obesity
• African American race
• Low socioeconomic status
• Advanced maternal age

Given the potential severity of preeclampsia with severe features, it is essential to closely monitor patients with risk factors and promptly diagnose and manage the condition to prevent severe morbidity and mortality 1.

From the Research

Pregnancy-Related Complications

The patient is at greatest risk for the following pregnancy-related complications:

• D. Preeclampsia with severe features: This complication of pregnancy remains a leading cause of maternal morbidity and mortality 2.
• E. Preterm labor: Increased fetal morbidity and mortality occurs due to iatrogenic preterm delivery, fetal growth restriction, and placental abruption 3.

Risk Factors

The risk factors for preeclampsia include:

• Hypertension 2, 4
• Proteinuria 2, 4
• Renal impairment 2
• Thrombocytopenia 2
• Epigastric pain 2
• Liver dysfunction 2
• Hemolysis-elevated liver enzymes-low platelet count (HELLP) syndrome 2
• Visual disturbances 2
• Headache 2
• Seizures 2, 4

Management

The management of preeclampsia includes:

• Antihypertensive medications 2, 4
• Magnesium sulfate 2, 4, 3
• Delivery 2, 4, 5, 6
• Antenatal corticosteroids to promote fetal lung maturity 2