AssessmentsComplications during pregnancy: Pathology review
USMLE® Step 1 style questions USMLE
A 25-year-old woman comes to the clinic due to a progressive cough accompanied by mild hemoptysis. During the past 2 weeks, she has been experiencing non-productive cough, pelvic pressure, and mild vaginal bleeding. Six weeks ago, the patient had an abortion at 15 weeks gestation, and since then, her menstrual period had not yet returned. She is in good health, and she does not smoke or use alcohol or illicit drugs. She is sexually active with her male partner and currently does not use contraception. Temperature is 37.0°C (98.6°F), pulse is 100/min, and blood pressure is 135/85 mmHg. On physical examination, the uterus is soft and mildly enlarged. Vaginal examination shows minimal blood at the vaginal vault. The cervix is closed, non-erythematous. An x-ray of the chest is obtained and shows multiple, rounded nodules of variable size scattered throughout the lungs. Which of the following findings is most specific for this patient’s conditions?
Content Reviewers:Yifan Xiao, MD
26 year-old Effie is brought to the emergency department with severe lower abdominal pain and bloody vaginal discharge that began a few hours ago. Her last menstrual period was 7 weeks ago. She has been sexually active with multiple partners and uses condoms on occasion. Her past medical history is significant for pelvic inflammatory disease. On examination, her blood pressure is 80/40 mmHg and her pulse is 130 beats per minute. She is pale and her extremities are cold and clammy. Next to her, there’s also 37-year-old Kate who came in noting an abrupt onset of abdominal pain and continuous vaginal bleeding. She is going through week 28 of her fourth pregnancy and was involved in a car crash a couple of hours ago, but did not immediately seek medical care. On presentation, fetal heart rate and movement are significantly diminished. Laboratory studies reveal low platelets, prolonged PT and PTT and elevated d-dimers. Peripheral blood smear shows schistocytes.
Based on their initial presentation, both Effie and Kate have a form of pregnancy complication.
Now, the most common medical complication of pregnancy is hypertensive disorders of pregnancy. These are diseases that cause high blood pressure during pregnancy, either a systolic blood pressure higher than 140 mmHg, or a diastolic blood pressure higher than 90 mmHg, or both. So, when hypertension is diagnosed before 20 weeks gestation, it’s usually chronic hypertension, meaning that it’s not due to pregnancy.
After 20 weeks gestation, new onset hypertension without proteinuria or damage to other organs is gestational hypertension. Now if hypertension gets severe, meaning systolic blood pressure of 160 mmHg or greater and/or diastolic blood pressure of 110 mmHg or greater, it can often lead to organ damage. One key thing to look out for is the presence of proteinuria, or excessive amounts of protein in the urine, which is a marker of kidney damage. Other affected organs include the brain and liver.
Now, if the hypertension coexists with proteinuria or other organ dysfunction, then it’s called preeclampsia. Preeclampsia is more common during a person’s first pregnancy, in pregnancies with multiple gesta