Severe Features of Preeclampsia
The correct answer is B: creatinine level of 1.3 mg/dL, which meets the threshold for severe preeclampsia as defined by ACOG criteria (creatinine ≥ 1.1 mg/dL). 1
Analysis of Each Option
Option B: Creatinine 1.3 mg/dL (CORRECT)
- A creatinine level ≥ 1.1 mg/dL or twice the baseline value defines new onset or worsening renal insufficiency, which is a severe feature of preeclampsia. 1
- This patient's creatinine of 1.3 mg/dL clearly exceeds the 1.1 mg/dL threshold established by ACOG guidelines 1
- This criterion reflects significant maternal end-organ damage that increases morbidity and mortality risk 2, 3
Option C: Platelet Count 105,000/µL (INCORRECT)
- Thrombocytopenia becomes a severe feature only when platelets fall below 100,000/µL 1, 2
- This patient's platelet count of 105,000/µL is abnormal but does not meet the threshold for severe disease 1
- The ACOG guideline specifically states platelet count <100,000/microliter as the cutoff 1
- Platelet transfusion is considered when counts drop below 100×10⁹/L due to increased risk of abnormal coagulation 1
Option A: AST 35 units/L (INCORRECT)
- Elevated liver transaminases must be two times the upper limit of normal to qualify as a severe feature 1, 2
- An AST of 35 units/L is within normal range (typically <40 units/L) and does not indicate liver dysfunction 1
- This value shows no evidence of hepatocellular injury 3
Option D: Systolic BP 155 mm Hg (INCORRECT)
- Severe hypertension requires systolic BP ≥160 mm Hg or diastolic BP ≥110 mm Hg 1, 2
- A systolic BP of 155 mm Hg falls into the mild-to-moderate range (140-159 mm Hg systolic) 1
- While this BP is elevated and requires treatment, it does not constitute a severe feature by itself 2, 3
Complete Criteria for Severe Features
According to ACOG guidelines, severe features of preeclampsia include any of the following: 1, 2
- Blood pressure: ≥160 mm Hg systolic or ≥110 mm Hg diastolic (despite antihypertensive therapy)
- Thrombocytopenia: Platelet count <100,000/µL
- Liver dysfunction: Transaminases >2× upper limit of normal
- Renal insufficiency: Creatinine ≥1.1 mg/dL or doubling of baseline creatinine
- Pulmonary edema
- Cerebral or visual symptoms: New-onset headache unresponsive to medication or visual disturbances
- Severe persistent right upper quadrant or epigastric pain unresponsive to medication
Clinical Implications
- This patient requires immediate escalation of care with close monitoring, potential hospitalization, and consideration of delivery timing based on gestational age 2, 3
- Magnesium sulfate for seizure prophylaxis should be administered given the presence of severe features 1, 2
- Antihypertensive therapy should be optimized to maintain blood pressure in the mild range (140-159/90-109 mm Hg) 1
- At 33 weeks gestation with severe features, corticosteroids for fetal lung maturity and delivery planning should be considered 2, 3