Preeclampsia: a link between trophoblast dysregulation and an antiangiogenic state

A 24-year-old nulliparous woman developed mildly elevated blood pressure (140-150/90-100 mmHg) without proteinuria (20 mg protein in a 24-hour urine collection) at 30⁶/⁷ weeks of gestation. The fetus was small for gestational age (estimated fetal weight under the fifth percentile). At 32⁵/⁷ weeks of gestation, the patient complained of epigastric pain, blood pressure was 180/110 mmHg, proteinuria was documented (780 mg protein in a 24-hour urine collection), schistocytes were detected in the peripheral smear, platelet count was 60,000 cells per mm³, and serum glutamic oxaloacetic transaminase was 234 U/l. The patient was diagnosed with severe preeclampsia/HELLP syndrome. Antenatal steroids were administered to induce fetal lung maturity. She and her family want to know the causes of this condition, what treatment is available, and whether there are any long-term implications of this diagnosis.