Severe Preeclampsia and Oliguric Acute Tubular Necrosis Following Placental Abruption in a Dichorionic Diamniotic Twin Pregnancy

Preeclampsia remains a leading cause of maternal and perinatal mortality, largely attributed to abnormal placentation, incomplete spiral artery remodeling, and increased antiangiogenic factors. Established risk factors for preeclampsia include a history of preeclampsia, chronic hypertension, diabetes, obesity, advanced maternal age, and multiple gestation. This report details a case of a 31-year-old with a history of five total pregnancies, two term pregnancies, one preterm pregnancy, two induced abortions, and one living child (G5P2121) with a dichorionic diamniotic twin pregnancy who presented at 24 weeks and two days of gestation with severe preeclampsia and placental abruption of Twin A. Following emergent repeat low transverse cesarean, the patient developed evidence of reversible disseminated intravascular coagulation (DIC) and subsequent oliguric acute tubular necrosis (ATN). Aggressive blood pressure control with multiple intravenous antihypertensives led to improvement in urine output by postoperative day one and steady recovery of renal function throughout her hospitalization. Our case highlights the importance of early recognition and prompt management of hypertension in high-risk pregnancies, as well as the need for close surveillance in patients with significant risk factors, especially those with multiple gestations. Prompt blood pressure control and multidisciplinary care can avert renal replacement therapy in oliguric ATN complicating preeclampsia.