A 31-year-old multigravida at 29 weeks with pre-eclampsia with severe features is being managed expectantly. Which single investigation result would be an absolute indication to expedite delivery regardless of corticosteroid status?

• A Platelet count of 95,000 per microlitre
• B Serum creatinine of 1.1 mg/dL
• C 24-hour urine protein of 3.2 g
• D Persistent severe right upper quadrant pain with AST rising to 180 U/L ✓

Explanation

Severe persistent right upper quadrant or epigastric pain unresponsive to analgesia with rising transaminases suggests impending hepatic rupture or infarction and mandates immediate delivery even at extreme prematurity. Platelets between 50,000 and 100,000, creatinine just over 1.0 mg/dL, and heavy proteinuria alone can all be observed under close surveillance while steroids take effect, which is what makes option D the only non-deferrable finding here.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.