A Complex High-Risk Pregnancy with Second Trimester Superimposed Preeclampsia Following Vanishing Twin Syn-drome in a Patient with Previous Severe Preeclampsia and Cesarean Section: A Case Report

Abstract

Hypertensive disorders of pregnancy remain a major cause of maternal and perinatal morbidity and mortality. Superimposed preeclampsia is particularly challenging because it occurs in women with pre-existing chronic hypertension and is associated with increased risk of severe maternal and fetal complications. Vanishing twin syndrome may further increase obstetric risk, especially when associated with abnormal placentation and maternal vascular dysfunction. This case report describes a 35-year-old woman, gravida 5 para 3 abortus 1, at 21 weeks of gestation, who was admitted with severe nausea and vomiting. The pregnancy was complicated by hyperemesis gravidarum without dehydration, superimposed preeclampsia, previous severe preeclampsia, previous cesarean section, vanishing twin syndrome, and mild hypokalemia. Laboratory evaluation showed proteinuria +1, anemia, and hypokalemia with serum potassium of 3.1 mmol/L. The patient was managed with intravenous fluid therapy, antiemetics, gastric protection, potassium correction, supplementation, antibiotics, and close maternal-fetal monitoring. This case highlights the importance of early identification, multidisciplinary surveillance, and individualized management in high-risk pregnancies with overlapping maternal and placental risk factors.