A 28-year-old primigravida at 34 weeks presents with BP 158/106 mmHg, headache, and 2+ proteinuria. Platelet count is 92,000/µL, AST 110 U/L, and serum creatinine 1.3 mg/dL. She has no visual symptoms. Which single criterion BEST categorises this as severe pre-eclampsia by ACOG 2023 criteria?

• A Proteinuria of 2+
• B Platelet count < 100,000/µL
• C Systolic BP ≥ 160 mmHg on two occasions
• D Serum creatinine > 1.1 mg/dL ✓

Explanation

ACOG 2023 severe-feature criteria include serum creatinine > 1.1 mg/dL (or doubling in absence of renal disease), platelets < 100,000/µL, AST/ALT > 2× upper limit, pulmonary oedema, new-onset headache unresponsive to medication, and SBP ≥ 160 or DBP ≥ 110 on two readings. Proteinuria amount (2+) is NOT a severe feature. Platelet 92,000 also qualifies, but the question asks which SINGLE criterion is best from the list given; creatinine 1.3 > 1.1 mg/dL is a definitive severe feature irrespective of BP. Option C requires SBP ≥ 160, which is not met here.

Reference: Williams Obstetrics, 26th ed.

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