According to ISSHP (International Society for the Study of Hypertension in Pregnancy) 2018 classification, which of the following is a CORRECT criterion distinguishing pre-eclampsia from gestational hypertension, even in the ABSENCE of proteinuria?
- A New-onset maternal thrombocytopenia (<150,000/µL) with hypertension after 20 weeks ✓
- B Diastolic BP ≥ 90 mmHg on two readings
- C Elevated serum uric acid above 6 mg/dL
- D Presence of fetal growth restriction with oligohydramnios
Correct answer: A. New-onset maternal thrombocytopenia (<150,000/µL) with hypertension after 20 weeks
Explanation
Per ISSHP 2018 (and ACOG guidelines), pre-eclampsia can be diagnosed without proteinuria if new-onset hypertension (≥140/90 after 20 weeks) is accompanied by any one of: thrombocytopenia (<100,000/µL per ACOG, or <150,000/µL per ISSHP), impaired liver function, new renal insufficiency, pulmonary edema, or new-onset headache unresponsive to medication. Elevated uric acid is a supportive finding but not a diagnostic criterion. FGR alone does not fulfill the diagnostic requirement. This expansion beyond the proteinuria criterion is a major contemporary change in definition.
Reference: Williams Obstetrics, 26th ed.
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