A 23-year-old G1P0000 without prior past medical history is 31 weeks pregnant with prenatal care presents with complaints of worsening leg and face swelling for the past 2 days now seeks care because of headache, diarrhea, nausea, and vomiting. On exam she is found to have a blood pressure of 120/86, edema, and brisk deep tendon re fl exes. Laboratory testing revealed hemoglobin 11.3 g/dl, platelet count 141,000/ m l white blood count 18,000/ m l, creatinine 1.1 mg/dl, aspartate aminotransferases (AST) 65 U/l, lactate dehydrogenase (LDH) 400 U/l, total bilirubin 1.1 mg/dl, prothrombin time (PT) 14.7 s, ammonia of 90 mcg/dl, blood glucose 139 mg/dl, calcium 7.3 mg/dl, and uric acid of 6.0 mg/dl. The urinalysis demonstrated WBC's 3-5/hpf, RBC's 3-5/hpf-non-dysmorphic, renal tubular epithelial cells were seen and a urine protein to creatinine ratio of 2. One day after hospitalization the patient's blood pressure was 145/87 with a similar blood pressure 6 h later.
Case 2A 38-year-old G4P2022 at 32 weeks gestational age who presents to clinic for her scheduled prenatal visit, and her blood pressure is found to be 147/92. Urine dip was negative for protein. She returned the following day with a 24 h urine collection which was negative for proteinuria again and her blood pressure was 156/94. She denied headache, vision changes, abdominal pain, or peripheral edema. Laboratory testing revealed hemoglobin 10 g/dl, platelet count 79,000, white blood count 13,270, creatinine 1.9 mg/dl, AST 92 U/l, and alanine aminotransferases (ALT) 120 U/l, and LDH of 672 U/l. A peripheral smear was signi fi cant for moderate shistocytes. The patient was admitted and given antenatal corticosteroids for fetal lung development in anticipation of preterm delivery. On hospital day 3, the patient developed severe right upper quadrant (RUQ) pain. Laboratory values were repeated and revealed hemoglobin 10.5 g/dl platelet count 85,000, white blood count 11,360, creatinine 1.8 mg/dl, AST 94, and ALT 98.
