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Abstract
Severe preeclampsia rarely occurs prior to 20 weeks of gestation except in pregnancies with triploidy. The patient reported herein is a 29-year-old primigravida who developed severe preeclampsia at 20 weeks of gestation. Evaluation of the pregnancy demonstrated a markedly abnormal quadruple screen. Amniocentesis demonstrated a fetus with triploidy, despite a normal appearance.
Keywords: Preeclampsia, triploidy, inhibin, quadruple screen
Introduction
We report herein the case of a patient with a 19-week pregnancy complicated by first and second trimester bleeding. At 19 weeks, the quadruple screen was markedly abnormal and a fetus with triploidy was identified.
Case
The patient is a 29-year-old primigravida who first presented at 15 weeks gestation for a second opinion due to persistent vaginal bleeding which started at 8 weeks. She reported no other problems, but felt that her abdomen was larger than it should be. An ultrasound done at 16 weeks gestation revealed a single intrauterine pregnancy with appropriate fetal biometry and a normal anatomic survey. The placenta appeared abnormal, and at the time it was felt to be consistent with a subchorionic hemorrhage.
A repeat ultrasound exam at 19 weeks gestation continued to demonstrate a normal appearing fetus with no change in the placental appearance. The vaginal bleeding persisted and her blood pressure was elevated to 148/84. There was no proteinuria and complete blood count and liver function tests were normal. She gave no history of chronic hypertension. A quadruple screen was drawn on that visit.
One week later she returned to recheck her blood pressure and review the results of the quadruple screen, which demonstrated an elevated dimeric inhibin A of 18 475 pg/mL (109.42 multiples of the median (MoM)), an elevated maternal serum alphafetoprotein (MS-AFP) of 388.1 ng/mL (8.83 MoM), and an elevated beta-human chorionic gonadotropin (hCG) level of 495 727.5...