A 32-year-old primigravida at 28 weeks of gestation presents with blood pressure of 160/110 mmHg on two occasions 4 hours apart. Urinalysis shows 2+ proteinuria. What is the most common cause of maternal mortality in pregnancy-induced hypertension?
A. Pulmonary edema
B. Placental abruption
C. Cerebral hemorrhage
D. Acute renal failure
Explanation
Most Common Cause of Maternal Mortality in Preeclampsia/Eclampsia
Key Point
Cerebral hemorrhage (intracranial hemorrhage) is the leading cause of maternal death in pregnancy-induced hypertension, accounting for approximately 50–60% of hypertension-related maternal deaths.
Mechanism of Cerebral Hemorrhage in Preeclampsia
1.
Severe hypertension → disruption of cerebral autoregulation
2.
Endothelial dysfunction → loss of protective vasodilation
3.
Vasospasm and microangiopathy → ischemia and edema
4.
Rupture of small cerebral vessels → hemorrhage
Why Cerebral Hemorrhage Dominates Mortality
High-YieldNEET PG
In eclampsia, the sudden elevation of blood pressure (often >180/120 mmHg) overwhelms the brain's autoregulatory mechanisms, leading to either:
Hemorrhagic stroke (more common in severe hypertension)
Hypertensive encephalopathy with seizures
Comparative Frequency of Other Complications
Table
Complication
Frequency in Severe Preeclampsia
Mortality Rate
Cerebral hemorrhage
50–60% of deaths
Highest
Pulmonary edema
5–10% of cases
Moderate
Acute renal failure
3–5% of cases
Moderate
Placental abruption
5–15% of cases
Variable
HELLP syndrome
10–20% of cases
1–3%
Clinical Pearl
The presence of persistent headache, visual disturbances, or altered consciousness in a patient with severe preeclampsia should raise suspicion for impending cerebral hemorrhage or hypertensive encephalopathy.
Warning
Acute renal failure is a common complication but accounts for fewer deaths than cerebral hemorrhage. Similarly, pulmonary edema occurs but is less lethal than intracranial hemorrhage.
Management to Prevent Cerebral Hemorrhage
Antihypertensive therapy: IV labetalol or IV hydralazine to target MAP <140 mmHg
Seizure prophylaxis: IV magnesium sulfate (gold standard)
Delivery: Definitive management; timing depends on gestational age and severity
Williams Obstetrics 26e Ch 34
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