Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (281 page)

References

1.  Wallis AB, Saftlas AF, Hsia J, et al. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987–2004.
Am J Hypertens.
2008;21:521.

2.  Maynard SE, Karumanchi SA. Angiogenic factors and preeclampsia.
Semin Nephrol.
2011;31:33.

3.  Cukle H, Sehmi I, Jones R. Maternal serum Inhibin A can predict preeclampsia.
Br J Obstet Gynaecol.
1998;105:1101.

ECLAMPSIA

   Definition

Eclampsia is the new onset of seizures or coma without other neurologic condition occurring in a woman who meets the criteria for preeclampsia. Approximately 20% of women who develop eclampsia have only mild hypertension and may have no evidence of proteinuria or edema
¹
. Eclampsia is a severe form of the preeclampsia eclampsia continuum and remains a common cause of maternal death. Seizures are believed to result from severe hypertension resulting in hypertensive encephalopathy
²
. Stroke with cerebral hemorrhages is the cause of death in up to 20% of patients with eclampsia
³
.

   Laboratory Findings

   Laboratory findings due to complications (e.g., cerebral hemorrhage, pulmonary edema, renal cortical necrosis).

   MgSO
₄
treatment requires urine output ≥100 mL/4 hours. Monitoring serum magnesium levels is not required.

   Beware of associated or underlying conditions (e.g., hydatidiform mole, twin pregnancy, prior renal disease, DM, or nonimmune hydrops fetalis).

References

1.  Sibai BM. Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases.
Am J Obstet Gynecol.
1990;163:1049

2.  Zeeman GG, Fleckenstein JL, Twickler DM, et al. Cerebral infarction in eclampsia.
Am J Obstet Gynecol.
2004;190:714.

3.  Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
Lancet.
2002;360:1903.

TROPHOBLASTIC NEOPLASMS

   Definition

Gestational trophoblastic disease is due to a group of abnormal gestations and neoplasms arising from the trophoblast associated with pregnancy. Most common is the partial hydatidiform mole (PHM) followed by complete hydatidiform mole (CHM), placental site trophoblast tumor, and choriocarcinoma. Risk factors include advanced maternal age, Asian ethnicity, lower social–economic status, and a prior molar pregnancy.

   Clinical Presentation

PHM
occurs in one in 100 pregnancies. It develops when a normal egg is fertilized by two spermatozoa or one spermatozoon that has undergone nondisjunction in meiosis resulting in triploidy (see eBook Figure 8-16A–C).

   Laboratory Findings

   HCG levels are variable and spontaneously regress in >95% of cases requiring chemotherapy.

   Endometrial curettings reveal hydropic and normal villi, amniotic membranes with or without fetal parts. A fetus if present may express syndactyly.

   Histologically, there is focal mild syncytial trophoblastic hyperplasia. A p57 immunostain will be positive.