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Answer 4
  1. Preeclampsia. This patient has had underlying chronic essential hypertension throughout most of her pregnancy but has now developed preeclampsia. Patients with hypertension often have decreased blood pressures during the first trimester, but by the third trimester, blood pressures increase to values seen prior to pregnancy. However, patients with chronic hypertension have a fivefold higher risk of preeclampsia. The rise in blood pressure to above baseline values, coinciding with the development of proteinuria and edema, is diagnostic of preeclampsia. Preexisting hypertension also increases the risk of intrauterine growth restriction, placental abruption, and mid-trimester fetal death.

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