A 28-year-old primigravida at 30 weeks has blood pressure 152/102 mmHg on two occasions 4 hours apart. Urine protein-to-creatinine ratio is 0.15. She has persistent right upper quadrant tenderness. Platelet count is 110,000/µL. AST is 78 U/L (upper limit of normal 40 U/L). Which of the following best describes her condition?
- A Gestational hypertension
- B Pre-eclampsia with severe features ✓
- C Pre-eclampsia without severe features
- D Chronic hypertension with superimposed pre-eclampsia
Correct answer: B. Pre-eclampsia with severe features
Explanation
According to ACOG 2020, severe features include persistent right upper quadrant or epigastric pain (indicating hepatic involvement) and thrombocytopenia below 100,000/µL, though some guidelines use elevated transaminases twice normal. Here, platelets are above 100,000 but RUQ pain with elevated AST qualifies as severe features. Proteinuria is not required for diagnosis under ISSHP/ACOG criteria if other end-organ dysfunction is present. Gestational hypertension lacks proteinuria or end-organ damage.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.