What classifies preeclampsia with severe features in a pregnant patient?

Preeclampsia with Severe Features: Diagnostic Criteria

The correct answer is (a): Elevated creatinine (>1.1 mg/dL or 2X baseline) classifies preeclampsia with severe features. 1, 2, 3

Severe Features Criteria

The diagnosis of preeclampsia with severe features requires the presence of any one of the following criteria in a patient with preeclampsia:

Renal Dysfunction

• Serum creatinine >1.1 mg/dL or doubling of baseline creatinine indicates significant renal impairment and meets criteria for severe features 1, 2, 3
• This threshold is lower than non-pregnant values because normal pregnancy physiology results in decreased creatinine levels 2

Hematologic Dysfunction

• Platelet count <100,000/µL (not <150,000/µL) defines clinically significant thrombocytopenia indicating severe disease 1, 2, 3
• A platelet count <150,000/µL represents mild thrombocytopenia but does not meet criteria for severe features 2

Hepatic Involvement

• Liver transaminases ≥2 times the upper limit of normal 1, 3
• Severe persistent right upper quadrant or epigastric pain (not right lower quadrant pain) unresponsive to medication, indicating liver capsule distension from hepatic edema 1, 2, 3

Neurologic Manifestations

• New-onset cerebral or visual disturbances unresponsive to medication 1, 3
• Persistent headache, blurred vision, scotomata, or cortical blindness indicating cerebral edema 2

Cardiovascular Complications

• Severe range blood pressure ≥160 mmHg systolic or ≥110 mmHg diastolic despite escalation of antihypertensive therapy 1, 3
• Pulmonary edema 1, 3

Why the Other Options Are Incorrect

Option (b): Platelets <150,000

• This represents mild thrombocytopenia and does not meet criteria for severe features 2
• The threshold for severe features is <100,000/µL 1, 2, 3

Option (c): Protein/Creatinine Ratio >0.3

• This ratio is used to diagnose preeclampsia, not to classify severity 2
• The degree of proteinuria does not correlate with disease severity or outcomes 2, 3
• Current guidelines explicitly state that proteinuria level should not be used to determine severity classification or timing of delivery 2

Option (d): Right Lower Quadrant Pain

• The correct location for pain indicating severe features is right upper quadrant or epigastric pain, not right lower quadrant 1, 2, 3
• This pain must be severe and persistent, unresponsive to medication 1, 2

Critical Clinical Pitfall

The presence of even a single severe feature mandates immediate management as severe disease, including consideration for magnesium sulfate prophylaxis, aggressive blood pressure control, and delivery planning 2. All preeclampsia can rapidly progress to life-threatening emergencies regardless of initial classification 2, 4.