Severe Preeclampsia and Oliguric Acute Tubular Necrosis Following Placental Abruption in a Dichorionic Diamniotic Twin Pregnancy

TL;DR

A 31-year-old woman with a twin pregnancy developed severe preeclampsia and kidney issues after a placental abruption, highlighting the need for careful monitoring and quick treatment.

Contribution

This case report emphasizes the importance of early hypertension management in high-risk twin pregnancies to prevent severe complications like acute tubular necrosis.

Findings

Severe preeclampsia and placental abruption in a twin pregnancy led to reversible DIC and oliguric ATN.

Aggressive blood pressure control improved urine output and renal function recovery.

Prompt management and multidisciplinary care prevented the need for renal replacement therapy.

Abstract

Preeclampsia remains a leading cause of maternal and perinatal mortality, largely attributed to abnormal placentation, incomplete spiral artery remodeling, and increased antiangiogenic factors. Established risk factors for preeclampsia include a history of preeclampsia, chronic hypertension, diabetes, obesity, advanced maternal age, and multiple gestation. This report details a case of a 31-year-old with a history of five total pregnancies, two term pregnancies, one preterm pregnancy, two induced abortions, and one living child (G5P2121) with a dichorionic diamniotic twin pregnancy who presented at 24 weeks and two days of gestation with severe preeclampsia and placental abruption of Twin A. Following emergent repeat low transverse cesarean, the patient developed evidence of reversible disseminated intravascular coagulation (DIC) and subsequent oliguric acute tubular necrosis (ATN). Aggressive blood pressure control with multiple intravenous antihypertensives led to improvement in urine output by postoperative day one and steady recovery of renal function throughout her hospitalization. Our case highlights the importance of early recognition and prompt management of hypertension in high-risk pregnancies, as well as the need for close surveillance in patients with significant risk factors, especially those with multiple gestations. Prompt blood pressure control and multidisciplinary care can avert renal replacement therapy in oliguric ATN complicating preeclampsia.

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