A 30-year-old primigravida at 34 weeks presents with BP 158/106 mmHg, 2+ proteinuria, and severe headache. Platelets are 88,000/µL, AST 210 U/L, and serum creatinine 1.4 mg/dL. Which single feature places her in the 'severe features' category of preeclampsia according to current ACOG classification?

• A 2+ proteinuria on dipstick
• B Thrombocytopenia <100,000/µL ✓
• C Blood pressure ≥150/100 mmHg on two occasions
• D Gestational age <37 weeks

Explanation

ACOG 2019 criteria designate severe features of preeclampsia as: BP ≥160/110 mmHg (not merely ≥150/100), thrombocytopenia <100,000/µL, impaired liver function (AST/ALT >2× normal), renal insufficiency (creatinine >1.1 mg/dL or doubling), pulmonary edema, or new-onset headache/visual symptoms. Thrombocytopenia <100,000/µL is explicitly a severe feature. Proteinuria quantity alone and gestational age are not determinants of severity; BP threshold is 160/110 for severe.

Reference: Williams Obstetrics, 26th ed.

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