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Answer 1
  1. Preeclampsia. This patient’s blood pressure is abnormally high for a pregnant woman, and she has preeclampsia. Preeclampsia occurs after 20 weeks of gestation. Although definitions of preeclampsia vary, current guidelines propose that a blood pressure greater than 140/90 mm Hg in the setting of more than 300 mg of protein in a 24-hour collection is suggestive of preeclampsia.1 Preeclampsia must be differentiated from chronic hypertension by the absence of hypertension and proteinuria prior to pregnancy. Gestational hypertension describes hypertension in pregnancy that is not associated with proteinuria and that resolves within 12 weeks postpartum. Preeclampsia most often occurs in nulliparous women, and risk factors include preexisting renal disease, multiple pregnancies, diabetes, and extremes of reproductive age. Although the etiology of preeclampsia has yet to be completely determined, it appears that impaired trophoblastic invasion, endothelial cell dysfunction, and antiangiogenic factors play a role. Treatment of preeclampsia includes hospitalization to monitor the mother and fetus, blood pressure control, and IV magnesium to prevent convulsions; early delivery is often required.

     Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1-S22.

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