Overview of the MLC

Case 30-1998: Preeclampsia

This case of a 30 year-old woman with systemic lupus erythematosus presenting with hypertension and proteinuria at 27 weeks gestation was read during the unit containing Reproductive Pathology and after the Renal/Endocrine unit. Study of the case was divided into four class sessions over a nine-day period and included quizzes at the beginning of sessions 1, 2 and 4.  The reading assignments included the case itself, two recent editorial updates on preeclampsia research and abstracts from two relevant research papers (see list below). All of this material was accessible remotely through the SUNY Upstate College of Medicine Library Electronic Reserve. In addition, data was abstracted from various sources to create a handout on hemodynamic, renal and endocrine changes during normal pregnancy and in patients with preeclampsia; this handout was made available on electronic reserve two days prior to the first class session. The case discussion (session #2) was led by a physician who directs a high-risk obstetrics unit. The editorials and research papers (assigned for session #4) centered on recent identification of placental-derived sFlt1 as a possible factor in the pathogenesis of preeclampsia.  sFlt1 is an inhibitor of placental growth factor and of vascular endothelial growth factor with potential detrimental effects on the maternal vasculature. Session #4 was led by a faculty member from the Department of Cell and Developmental Biology who focused on the biology of the vascular growth factors and issues of defective placentation. The sessions on the physiology of pregnancy and on the mechanisms of the hemodynamic, renal and endocrine derangements in preeclampsia (sessions #1 and #3) were led by the course director, a renal pathologist. 

Session #1:            Quiz and discussion on handout:
                                  “Physiologic changes in normal pregnancy and in preeclampsia.”
Session #2:            Quiz and discussion on Case 30-1998 a
Session #3:            Discussion of pathophysiologic changes in preeclampsia 
Session #4:            Quiz and discussion on assigned supplemental articles:
                                   “Latest advances in understanding preeclampsia" b
                                   “Preeclampsia — searching for the cause”c
                                   “Circulating angiogenic factors and the risk of preeclampsia”d
                                          [Students responsible for abstract and figure 3 only]
                                   “Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to
                                    endothelial dysfunction, hypertension, and proteinuria in preeclampsia”e    
                                          [Students responsible for abstract and figure 6 only] 

References:

a   Anonymous. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises.
     Case 30-1998. A 30-year old woman with increasing hypertension and proteinuria.
      N Engl J Med. 1998;339(13):906-913.

b   Redman CW, Sargent IL. Science. 2005;308:1592-1594.

c   Solomon CG, Seely EW. N Engl J Med. 2004;350(7):641-642.

d   Levine RJ, Maynard SE, Qian C, et al. N Engl J Med. 2004;350(7):672-683.

e   Maynard SE, Min JY, Merchan J, et al. J Clin Invest. 2003;111(5):649-658.