A 28-year-old primigravida at 34 weeks presents with blood pressure of 156/106 mmHg on two readings 4 hours apart, proteinuria 2+ on dipstick, and platelet count of 88,000/µL. Serum AST is 98 IU/L. Which FIGO/ISSHP criterion confirms severe pre-eclampsia in this patient?
- A Proteinuria 2+ on dipstick alone
- B Thrombocytopenia below 100,000/µL with hepatic involvement ✓
- C Systolic BP ≥140 mmHg on two occasions
- D Gestational age below 37 weeks
Correct answer: B. Thrombocytopenia below 100,000/µL with hepatic involvement
Explanation
Severe features of pre-eclampsia per ISSHP/ACOG include thrombocytopenia (<100,000/µL) and hepatic dysfunction (elevated transaminases >2× normal). This patient's platelet count of 88,000/µL combined with AST 98 IU/L (>2× upper normal of ~40 IU/L) fulfils HELLP overlap and constitutes a severe feature. Dipstick proteinuria alone and gestational age are not severe-feature criteria; systolic ≥160 (not ≥140) is the BP threshold for severe designation.
Reference: Williams Obstetrics, 26th ed.
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