Which one of the following is a multisystem disorder characterized by development of hypertension (140/90) with proteinuria after the 20th week of pregnancy?

1. A

   Pre-eclampsia

2. B

   Essential hypertension

3. C

   Miscarriage

4. D

   All of these

Appeared in: AIIMS Raipur lecturer 2021

Explanation

• Pre-eclampsia is a pregnancy-specific syndrome characterized by the new onset of hypertension (BP ≥ 140/90 mmHg) after 20 weeks of gestation.
• A key diagnostic criterion is the presence of new-onset proteinuria (≥300 mg/24h or protein/creatinine ratio ≥0.3), which reflects kidney involvement.
• It is considered a multisystem disorder because the underlying pathology of endothelial dysfunction can affect the kidneys, liver, brain, and hematologic systems.
• The timing of onset after 20 weeks is crucial for differentiating it from chronic (essential) hypertension.

Why Other Options Were Wrong

• Option B: Essential hypertension, also known as chronic hypertension, is diagnosed before pregnancy or before the 20th week of gestation. The question specifies onset after the 20th week.
• Option C: A miscarriage is the spontaneous loss of a pregnancy before the 20th week. It is not a hypertensive disorder and does not match the clinical picture described.
• Option D: This option is incorrect because only one of the conditions, pre-eclampsia, matches all the criteria given in the question (hypertension, proteinuria, and onset after 20 weeks).

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Definition and characteristics of pre-eclampsia as background academic context rather than a clinical decision trigger.
• Accurately identifying pre-eclampsia is critical for maternal and fetal safety. It allows for timely intervention to prevent progression to severe complications like eclampsia (seizures), HELLP syndrome, placental abruption, and fetal growth restriction.
• Nursing care involves vigilant monitoring of blood pressure, urine protein, and signs of severe features (headache, visual changes, epigastric pain) to facilitate early management and decide on the timing of delivery, which is the definitive cure.
• What if? If the patient had hypertension before 20 weeks but developed new-onset proteinuria after 20 weeks, the diagnosis would be 'superimposed pre-eclampsia on chronic hypertension,' which carries an even higher risk of adverse outcomes.

How to Approach the Question

• First, break down the question stem into its key diagnostic components: 1) multisystem disorder, 2) hypertension (≥140/90), 3) proteinuria, and 4) onset after the 20th week of pregnancy.
• Next, evaluate each option against this specific set of criteria.
• Recall the definition of 'Essential hypertension'. This is chronic hypertension that exists before pregnancy or is diagnosed before 20 weeks. This does not match criterion #4.
• Recall the definition of 'Miscarriage'. This is pregnancy loss before 20 weeks and is not a hypertensive disorder. This does not match criteria #2, #3, or #4.
• Recall the definition of 'Pre-eclampsia'. This condition is defined by new-onset hypertension with proteinuria after 20 weeks. This matches all the key components of the question.
• Since only Pre-eclampsia fits the description perfectly, 'All of these' is incorrect. Select the option that is a direct match.

Concept Tested & Keywords

• Concept Tested: Definition and characteristics of pre-eclampsia
• Stem keywords: multisystem disorder, hypertension, proteinuria, 20th week of pregnancy
• Lead-in keywords: Which one
• Negative lead-in flag: false

Question ID

Q1_xSd26gu-MPn1hb3I87_

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 p. 1803-1805

E6 Obstetrics Williams p. 2-9