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ZyraDoc #58 - September 28, 2026

#57

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#59

A 29-year-old primigravida at 34 weeks' gestation presents with a 12-hour history of severe persistent frontal headache, visual blurry spots (scotomata), and persistent right upper quadrant abdominal pain.

On physical examination, her blood pressure is 174/112 mmHg measured twice 15 minutes apart, with 3+ hyperreflexia, 2 beats of ankle clonus, bilateral pedal edema, and localized right upper quadrant tenderness.

Laboratory evaluation reveals a urine protein-to-creatinine ratio of 0.85, serum creatinine of 1.3 mg/dL, elevated AST (145 U/L) and ALT (160 U/L), and a platelet count of 82,000/µL, establishing a diagnosis of Preeclampsia with Severe Features.

Case Summary

Clinical Focus:

  • The diagnosis is Preeclampsia with Severe Features.

Aetiology/Cause:

  • Incomplete remodeling of maternal spiral arteries by cytotrophoblasts, leading to high-resistance placental hypoperfusion and ischemia.
  • Release of anti-angiogenic factors (e.g., sFlt-1 and soluble endoglin) into the maternal circulation, driving systemic endothelial cell dysfunction.
  • Systemic vasospasm, increased vascular permeability, and microvascular thrombosis affecting multiple organ systems (renal, hepatic, cerebral, hematologic).

Clinical Features:

  • Severe hypertension (systolic BP ≥ 160 mmHg or diastolic BP ≥ 110 mmHg on two occasions at least 4 hours apart).
  • Cerebral/visual symptoms: severe persistent headache, scotomata, photopsia, or altered mental status.
  • Hepatic dysfunction: severe persistent right upper quadrant or epigastric pain, elevated transaminases (> 2x upper limit of normal).
  • Thrombocytopenia (platelets < 100,000/µL) and progressive renal insufficiency (serum creatinine > 1.1 mg/dL or doubling of baseline).

Diagnosis and Investigations:

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