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Zorluk: OrtaObstetric Complications

Match each maternal clinical presentation occurring during the third trimester with the most accurate obstetric diagnosis.

  • A patient at 36 weeks gestation develops acute nausea, jaundice, profound hypoglycemia, and prolonged coagulation times (PT/aPTT).Acute fatty liver of pregnancy
  • A patient at 37 weeks gestation presents with a blood pressure of 165/110 mm Hg, right upper quadrant pain, and a platelet count of 75,000/mm³.HELLP syndrome
  • A patient at 34 weeks gestation with normal blood pressure reports intense, worsening pruritus exclusively on her palms and soles, especially at night.Intrahepatic cholestasis of pregnancy
  • A patient at 38 weeks gestation presents with new-onset blood pressure of 145/95 mm Hg and 350 mg of proteinuria in a 24-hour collection, but is otherwise asymptomatic.Preeclampsia without severe features

Cevap

Acute fatty liver of pregnancy pairs with hypoglycemia and coagulopathy; HELLP syndrome pairs with severe hypertension, right upper quadrant pain, and thrombocytopenia; Intrahepatic cholestasis of pregnancy pairs with isolated palmar and plantar pruritus; Preeclampsia without severe features pairs with isolated mild hypertension and proteinuria.
Each diagnosis is identified by its distinct clinical signature: AFLP presents with synthetic liver failure (hypoglycemia, coagulopathy); HELLP presents with microangiopathy (thrombocytopenia, severe hypertension); intrahepatic cholestasis presents with localized palmar/plantar pruritus; and mild preeclampsia presents with isolated hypertension and proteinuria without end-organ damage.

Adım Adım Çözüm

1
Evaluate the patient's blood pressure and urinalysis to determine if a hypertensive disorder of pregnancy is present.
Two patients have hypertension (one severe with thrombocytopenia, one mild with isolated proteinuria), and two have normotension.
This immediately separates preeclampsia spectrum disorders from other hepatic or metabolic conditions.
2
Analyze the metabolic and hematologic derangements in the patients with liver involvement.
The patient with profound hypoglycemia and prolonged PT/aPTT has acute fatty liver of pregnancy. The patient with severe hypertension and low platelets has HELLP syndrome.
AFLP causes primary liver synthetic failure (low glucose, high PT/aPTT), whereas HELLP is a microangiopathic process causing platelet consumption.
3
Assess isolated dermatologic symptoms.
The normotensive patient with palmar/plantar pruritus has intrahepatic cholestasis of pregnancy.
This classic symptom distinguishes it from hypertensive disorders and physiologic skin changes.

Anahtar Kavram

Differentiating hepatic and hypertensive complications of pregnancy by clinical features.
Tahmini Süre:1m 30s
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