A 38-year-old woman gravida 2 para 1, at 30 weeks gestation comes to the emergency department because of progressive swelling in her face and hands. At a prenatal visit 2 weeks earlier, she was diagnosed with gestational hypertension. Her current medications include methyldopa and a multivitamin. The patient has not urinated in the last 12 hours despite an increase in fluid intake. She appears anxious. Her pulse is 95/min, and blood pressure is 160/102 mm Hg. Bladder catheterization yields a total of 15 mL of dark urine. Which of the following pathologic factors is the most likely cause of this patient's decreased urine output?

Question

A 38-year-old woman gravida 2 para 1, at 30 weeks gestation comes to the emergency department because of progressive swelling in her face and hands. At a prenatal visit 2 weeks earlier, she was diagnosed with gestational hypertension. Her current medications include methyldopa and a multivitamin. The patient has not urinated in the last 12 hours despite an increase in fluid intake.  She appears anxious. Her pulse is 95/min, and blood pressure is 160/102 mm Hg. Bladder catheterization yields a total of 15 mL of dark urine. Which of the following pathologic factors is the most likely cause of this patient's decreased urine output?

Quizplus · Accepted Answer

Eductional Objective: Preeclampsia is new-onset hypertension at 20 weeks gestation or more plus proteinuria and/or signs of end-organ damage.  Preeclampsia is caused by widespread maternal endothelial cell damage due to release of antiangiogenic factors from an ischemic placenta.  The result is widespread capillary leakage (proteinuria, edema) and vasospasm (hypertension, end-organ hypoperfusion eg, renal failure).

A 38-Year-Old Woman Gravida 2 Para 1, at 30 Weeks