A 32-year-old primigravida at 34 weeks presents with blood pressure 158/104 mmHg and proteinuria 2+ on dipstick. She denies headache, visual symptoms, or epigastric pain. Platelet count is 142,000/μL, ALT 38 U/L, and serum creatinine 0.9 mg/dL. Which criterion from the ISSHP 2018 classification best categorizes her condition as severe pre-eclampsia?

• A Proteinuria 2+ on dipstick
• B Blood pressure ≥160/110 mmHg on two occasions 4 hours apart
• C Platelet count below 150,000/μL
• D Serum creatinine ≥1.1 mg/dL in the absence of other renal disease ✓

Explanation

The ISSHP 2018 and ACOG criteria define severe features of pre-eclampsia; serum creatinine ≥1.1 mg/dL (or doubling from baseline in absence of other renal disease) qualifies as a severe feature even without blood pressure meeting the ≥160/110 threshold. Blood pressure must be ≥160/110 mmHg confirmed on two readings 4 hours apart to qualify for that severe criterion — this patient's BP is 158/104, just below the threshold. Dipstick 2+ proteinuria alone is not a severe feature; quantitative proteinuria >5 g/24h (or >300 mg/g spot ratio) is required for severe proteinuria. Platelets <100,000/μL (not <150,000) constitutes a severe feature.

Reference: Williams Obstetrics, 26th ed.

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