A 27-year-old primigravida at 28 weeks gestation presents with blood pressure 154/102 mmHg on two occasions 4 hours apart and proteinuria of 3.2 g in a 24-hour urine collection. Platelets are 210,000/µL, serum creatinine is 0.8 mg/dL, and liver transaminases are normal. She has no headache, visual symptoms, or epigastric pain. According to ACOG 2020 criteria, which of the following is the correct classification and management?
- A Pre-eclampsia with severe features; deliver immediately at 28 weeks
- B Gestational hypertension; manage with outpatient blood pressure monitoring
- C Pre-eclampsia without severe features; expectant management until 37 weeks with close monitoring ✓
- D Pre-eclampsia without severe features; deliver at 34 weeks regardless of course
Correct answer: C. Pre-eclampsia without severe features; expectant management until 37 weeks with close monitoring
Explanation
ACOG 2020 defines pre-eclampsia as hypertension with proteinuria or severe features. This patient has hypertension and significant proteinuria (>300 mg/24h) but no severe features (normal platelets, normal LFTs, no symptoms). Pre-eclampsia without severe features is managed expectantly until 37 weeks. The 24-hour urine protein of 3.2 g no longer classifies as a severe feature per ACOG 2020, making option A incorrect.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.