A woman with severe pre-eclampsia at 34 weeks has an sFlt-1/PlGF ratio of 38. According to current ISSHP 2018 guidelines, which feature is considered a criterion for 'pre-eclampsia with severe features' that mandates delivery regardless of gestational age?
- A Creatinine ≥1.1 mg/dL in the absence of prior renal disease ✓
- B Proteinuria >300 mg/24 hours
- C Systolic BP ≥140 mmHg on two occasions
- D Edema of the lower extremities
Explanation
Per current ACOG/ISSHP guidelines, severe features of pre-eclampsia include: systolic BP ≥160 or diastolic BP ≥110 mmHg, thrombocytopenia (<100,000/µL), impaired liver function (elevated transaminases ≥2x normal or severe RUQ/epigastric pain), new renal insufficiency (creatinine ≥1.1 mg/dL or doubling of creatinine), pulmonary edema, new-onset headache unresponsive to medication, or visual disturbances. Proteinuria >300 mg/24h is a diagnostic criterion for pre-eclampsia but not specifically a severe feature threshold; edema is no longer a diagnostic criterion at all; systolic BP ≥140 is the threshold for diagnosis, not severe features.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.