Abstract: SA-PO380
In Vitro Fertilization (IVF): Early-Onset Preeclampsia Before 16 Weeks' Gestation
Session Information
- Genetic and Diagnostic Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 2000 Women's Health and Kidney Diseases
Authors
- Khan, Bilal shahzad azam, Henry Ford Hospital, Detroit, Michigan, United States
- Sharma, Yuvraj, Henry Ford Health system, Bloomfield Hills, Michigan, United States
- Soman, Sandeep S., Henry Ford Hospital, Detroit, Michigan, United States
- Al jandali, Mhd hussam, Henry Ford Hospital, Detroit, Michigan, United States
- Reddy, Snigdha, Henry Ford Hospital, Detroit, Michigan, United States
Introduction
Preeclampsia is a hypertensive pregnancy disorder diagnosed in women presenting with new onset hypertension and proteinuria > 20 weeks gestation. IVF has been suggested as a risk factor for preeclampsia. We describe a rare case of early onset preeclampsia < 20 weeks gestation conceived via IVF.
Case Description
A 38-year-old G2P0010 patient at 15w5d gestation conceived via IVF presented with headache and worsening bilateral lower extremity swelling. She was experiencing intermittent headaches and occasional foamy urine for a few weeks before presentation. No past or family history of renal disease. BP was 230/107mm Hg at presentation, UA showed >500 mg/dl protein with no hematuria, 24-hour urine protein was 18 gm/day, serum creatinine 0.76 mg/dl, ALT 88 IU/L, AST 55 IU/L, Platelets 165 K/µL. Transvaginal ultrasound(US) confirmed stated gestational age. Renal US was unremarkable. Relevant serologies were negative. Renal biopsy (see image) showed glomerular capillary endotheliosis and new subendothelial basement membrane (BM) formation creating BM double contours consistent with preeclampsia. The patient opted for termination of pregnancy at 17w2d. BP, transaminitis and proteinuria normalized after one week of pregnancy termination.
Discussion
Preeclampsia presenting before 20 weeks gestation is rare, and a case associated with IVF as a sole risk factor is unique. Other conditions like molar pregnancy, triploidy, lupus nephritis, antiphospholipid antibody syndrome, thrombotic thrombocytopenia, acute fatty liver of pregnancy, hemolytic uremic syndrome and fetal hydrops should be excluded. Common risk factors for preeclampsia are prior pre-eclampsia, chronic hypertension, pre-gestational diabetes, obesity and IVF. Embryo preservation, implantation techniques and placental development with IVF have been suggested as a cause for this serious systemic hypertensive disorder. This is the first reported case of early–onset preeclampsia before 16 weeks gestation with IVF.