Maternal Ascites as an Atypical Presentation of Severe Preeclampsia: A Case Report.
Kylie Rayburn, Jesse Cottrell, Amanda Pauley
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Case in brief
A 23-year-old woman at 30 weeks and 2 days’ gestation, admitted with fetal growth restriction and intermittent absent end-diastolic flow on umbilical artery Doppler, developed severe preeclampsia superimposed on chronic hypertension. She had profound capillary leak with marked third spacing, including 1.8 L of ascites and pleural effusions. Recognizing the fluid accumulation as part of severe preeclampsia informed management and assessment of maternal and fetal risk, including the need for delivery. The report emphasizes that this presentation can complicate clinical evaluation.
What made this case unusual
The severe preeclampsia was accompanied by profound capillary leak, large-volume ascites, and pleural effusions—an uncommon pattern of third spacing in this setting.
Diagnostic / clinical pearl
In a patient with severe hypertensive disease of pregnancy, unexplained ascites or other marked fluid accumulation may reflect preeclampsia-associated capillary leak and should be considered in assessing disease severity.