A 26-Year-Old Primigravid Woman at 20 Weeks Gestation Comes to the Emergency

Multiple Choice

A 26-year-old primigravid woman at 20 weeks gestation comes to the emergency department due to joint pain and swelling in her hands and feet over the past day.  The patient reports good fetal movement and has no abdominal pain, bleeding, leakage of fluid, headaches, or visual changes.  She has a history of systemic lupus erythematosus that was managed with hydroxychloroquine, which the patient stopped taking prior to conception.  Blood pressure is 150/95 mm Hg; 5 minutes later, following rest in the lateral recumbent position, it is 140/95 mm Hg.  Fetal heart rate by Doppler ultrasound is 145/min.  Physical examination shows bilateral 2+ pitting edema of the legs and a red macular eruption on the cheeks.  Laboratory results are as follows: Serum electrolytes, liver function tests, and coagulation studies are within normal limits.  Which of the following is the most likely diagnosis for this patient?

A) Gestational hypertension
B) HELLP syndrome
C) Hemolytic uremic syndrome
D) Preeclampsia
E) Systemic lupus erythematosus flare