A 32-year-old primigravida at 34 weeks of gestation presents with a blood pressure of 160/110 mmHg, headache, and epigastric pain. Urine dipstick shows 3+ proteinuria. Which investigation is most appropriate to confirm the diagnosis of severe preeclampsia and guide immediate management?

Explanation

## Investigation of Choice in Severe Preeclampsia **Key Point:** In a patient with clinical features of severe preeclampsia (BP ≥160/110 mmHg, symptoms, and proteinuria), serum creatinine and liver function tests (LFTs) are the most appropriate next investigations to assess maternal organ involvement and confirm severity. ### Why Serum Creatinine and LFTs? Severe preeclampsia is defined not only by blood pressure and proteinuria but also by the presence of severe features: | Feature | Significance | |---------|-------------| | Elevated serum creatinine (>1.1 mg/dL) | Indicates renal involvement; suggests progression to HELLP syndrome | | Elevated transaminases (AST/ALT >2× ULN) | Indicates hepatic involvement; marker of severe disease | | Thrombocytopenia (<100,000/μL) | Part of HELLP syndrome criteria | | Pulmonary edema / cerebral symptoms | Already present clinically | **High-Yield:** The presence of **any one severe feature** converts preeclampsia to "severe preeclampsia" and mandates urgent delivery. Serum creatinine and LFTs are rapid, bedside-available tests that identify organ dysfunction and guide the urgency and mode of delivery. ### Clinical Pearl Epigastric pain + elevated transaminases = hepatic capsule distension and HELLP syndrome risk. This combination demands immediate delivery (within 24–48 hours) and intensive monitoring. ### Diagnostic Criteria for Severe Preeclampsia 1. **BP ≥160/110 mmHg** (present in this case) 2. **Symptoms** (headache, epigastric pain — present in this case) 3. **Proteinuria ≥3+** (present in this case) 4. **Severe features** (organ dysfunction): - Serum creatinine >1.1 mg/dL - Platelets <100,000/μL - Microangiopathic hemolytic anemia - Elevated liver enzymes - Pulmonary edema - Cerebral or visual symptoms **Mnemonic: HELLP** — **H**emolysis, **E**levated **L**iver enzymes, **L**ow **P**latelets. LFTs and CBC are essential to rule out HELLP. [cite:Williams Obstetrics 26e Ch 34]