A 36-year-old primigravida develops peripheral edema late in the second trimester. On physical examination, her blood pressure is 155/95 mm Hg. Urinalysis shows 2+ proteinuria, but no blood, glucose, or ketones. At 36 weeks, she gives birth to a normal viable but low-birth-weight infant. Her blood pressure returns to normal, and she no longer has proteinuria. Which of the following pathologic findings is most likely to be found on examination of the placenta?
A 36-year-old primigravida develops peripheral edema late in the second trimester. On physical examination, her blood pressure is 155/95 mm Hg. Urinalysis shows 2+ proteinuria, but no blood, glucose, or ketones. At 36 weeks, she gives birth to a normal viable but low-birth-weight infant. Her blood pressure returns to normal, and she no longer has proteinuria. Which of the following pathologic findings is most likely to be found on examination of the placenta?
💡 Explanation
## **Core Concept**
The clinical presentation described for the 36-year-old primigravida, including late second-trimester onset of peripheral edema, hypertension (155/95 mm Hg), and proteinuria (2+), is indicative of **preeclampsia**. Preeclampsia is a pregnancy complication characterized by new-onset hypertension and often accompanied by significant proteinuria after 20 weeks of gestation. It can lead to complications for both mother and fetus if not managed properly.
## **Why the Correct Answer is Right**
The correct answer, **placental infarctions and fibrinoid necrosis**, is most closely associated with preeclampsia. In preeclampsia, there is abnormal placentation leading to a high-resistance, low-capacity uteroplacental circulation. This results in **ischemia** of the placenta, which can cause **infarctions** and **fibrinoid necrosis** within the placenta. These changes are pathognomonic for preeclampsia and contribute to the clinical manifestations of the disease, including hypertension and proteinuria.
## **Why Each Wrong Option is Incorrect**
- **Option A:** While some degree of **maternal vascular malperfusion** can be seen in normal pregnancies, the extent and specific features seen in preeclampsia (like significant infarctions and fibrinoid necrosis) are not typical of normal pregnancies.
- **Option B:** **Chorionic villus edema** can be seen in conditions like molar pregnancies or in the context of fetal hydrops but is not specifically characteristic of preeclampsia.
- **Option D:** **Fetal vascular malperfusion** can occur in various conditions, including fetal growth restriction and diabetes, but it is not the hallmark of preeclampsia.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that preeclampsia can have a significant impact on both maternal and fetal health. The condition necessitates careful monitoring and management to prevent complications such as eclampsia (seizures), stroke, and placental abruption. Delivery of the baby is often the definitive treatment for preeclampsia, as seen in this case.
## **Correct Answer:** . **Placental infarctions and fibrinoid necrosis**
✓ Correct Answer: D. Multiple infarcts
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