A 34-year-old woman at 35 weeks with chronic hypertension presents with BP 162/108 mmHg, proteinuria 300 mg on a spot protein-creatinine ratio of 0.5, platelets 105,000 per microlitre, and normal liver enzymes and creatinine. According to ACOG criteria, how should she be classified?

• A Chronic hypertension with superimposed pre-eclampsia with severe features ✓
• B Chronic hypertension with superimposed pre-eclampsia without severe features
• C Preeclampsia with severe features de novo
• D Chronic hypertension with acute severe hypertension requiring classification as gestational hypertension

Explanation

She has known chronic hypertension with new-onset proteinuria plus a severe-range blood pressure (systolic 160 or more, or diastolic 110 or more), fulfilling criteria for superimposed pre-eclampsia with severe features. Without the severe-range BP and with milder findings it would be superimposed pre-eclampsia without severe features, but the BP decides it. De novo preeclampsia cannot be diagnosed when chronic hypertension predates 20 weeks, which kills option C.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.