A 30-year-old primigravida at 36 weeks presents with BP 158/104 mmHg, proteinuria 2+ on dipstick, and severe epigastric pain with right upper quadrant tenderness. Platelets are 88,000/µL and AST is 210 U/L. Which diagnostic label best fits her condition?
- A Gestational hypertension with incidental thrombocytopenia
- B Pre-eclampsia superimposed on chronic hypertension
- C Severe pre-eclampsia with HELLP syndrome ✓
- D Acute fatty liver of pregnancy
Correct answer: C. Severe pre-eclampsia with HELLP syndrome
Explanation
HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelets) is a severe variant of pre-eclampsia; the triad of epigastric pain, thrombocytopenia, and elevated transaminases in the context of hypertension and proteinuria confirms this diagnosis. Gestational hypertension lacks proteinuria or end-organ damage. Acute fatty liver of pregnancy also has hepatic dysfunction but the distinguishing features are microvesicular steatosis, hypoglycaemia, and coagulopathy without the specific HELLP criteria.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.