A 38-year-old primigravid woman at 34 weeks' gestation comes to the emergency department because of sudden-onset visual changes and headache. At a prenatal visit 2 weeks earlier, she was diagnosed with gestational hypertension. Amniocentesis with chromosomal analysis was performed at 16 weeks' gestation and showed no abnormalities. Her current medications include methyldopa and a multivitamin. She appears anxious. Her pulse is 90/min, respirations are 24/min, and blood pressure is 170/100 mm Hg. Crackles are heard over both lung bases. Uterine examination shows a fundal height consistent in size with a 34 week gestation. Examination of the heart, abdomen, and extremities shows no abnormalities. Visual field testing shows partial loss of vision bilaterally. Which of the following is the most likely cause of this patient's symptoms?

Question

A 38-year-old primigravid woman at 34 weeks' gestation comes to the emergency department because of sudden-onset visual changes and headache. At a prenatal visit 2 weeks earlier, she was diagnosed with gestational hypertension. Amniocentesis with chromosomal analysis was performed at 16 weeks' gestation and showed no abnormalities. Her current medications include methyldopa and a multivitamin. She appears anxious. Her pulse is 90/min, respirations are 24/min, and blood pressure is 170/100 mm Hg. Crackles are heard over both lung bases. Uterine examination shows a fundal height consistent in size with a 34 week gestation. Examination of the heart, abdomen, and extremities shows no abnormalities. Visual field testing shows partial loss of vision bilaterally.  Which of the following is the most likely cause of this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: Preeclampsia causes widespread endothelial dysfunction, resulting in dysregulated vascular tone, increased vascular permeability, and decreased end-organ perfusion.  Therefore, a common presentation is headache with visual changes (eg, scotomata) due to dysregulated cerebral blood flow and retinal artery vasospasm.

A 38-Year-Old Primigravid Woman at 34 Weeks' Gestation Comes to the Emergency