Pregnancy-Induced Hypertension MCQ — NEET PG Practice Question | NEETPGAI
Pregnancy-Induced Hypertension
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According to current diagnostic criteria, what is the minimum proteinuria threshold required to diagnose preeclampsia with severe features in a non-diabetic pregnant woman?
A. ≥5.0 grams in 24-hour urine or protein-to-creatinine ratio ≥5.0 mg/mg
B. ≥1.0 gram in 24-hour urine or protein-to-creatinine ratio ≥1.0 mg/mg
C. ≥0.3 grams in 24-hour urine or protein-to-creatinine ratio ≥0.3 mg/mg
D. ≥2.0 grams in 24-hour urine or protein-to-creatinine ratio ≥2.0 mg/mg
Explanation
Diagnostic Criteria for Preeclampsia with Severe Features
Key Point
According to the 2013 ACOG guidelines (and reaffirmed in subsequent updates), the minimum proteinuria threshold to diagnose preeclampsia is ≥0.3 grams in 24-hour urine or a protein-to-creatinine ratio ≥0.3 mg/mg. Importantly, the 2013 ACOG criteria eliminated the ≥5.0 g/24 h proteinuria threshold as a criterion for "severe features," and no specific higher proteinuria threshold (e.g., ≥1.0 g or ≥2.0 g) is required to define severe preeclampsia by proteinuria alone.
Evolution of Diagnostic Criteria
Table
Criterion
Pre-2013
Current (2013 ACOG)
Minimum proteinuria for preeclampsia diagnosis
≥0.3 g/24 h
≥0.3 g/24 h (unchanged)
Proteinuria threshold for "severe" preeclampsia
≥5.0 g/24 h
Removed — proteinuria level alone no longer defines severity
Rationale for change
Proteinuria quantity poorly predicted outcomes
Severity defined by end-organ damage criteria, not proteinuria amount
Diagnostic Criteria for Preeclampsia (ACOG 2013)
Preeclampsia is diagnosed when:
Hypertension (≥140/90 mmHg on 2 occasions ≥4 hours apart) AND
Proteinuria (≥0.3 g/24 h, or protein-to-creatinine ratio ≥0.3 mg/mg, or urine dipstick ≥2+) OR
New-onset hypertension without proteinuria + one or more severe features
Severe Features Include (ACOG 2013):
1.
Systolic BP ≥160 mmHg or diastolic BP ≥110 mmHg (on 2 occasions ≥15 min apart)
2.
Platelet count <100,000/μL
3.
Serum creatinine >1.1 mg/dL (or doubling from baseline without other renal disease)
4.
Impaired liver function (elevated transaminases ≥2× normal) or severe persistent RUQ/epigastric pain
5.
Pulmonary edema
6.
New-onset headache unresponsive to medication, or visual disturbances
High-YieldNEET PG
The 2013 ACOG guidelines removed the ≥5.0 g/24 h proteinuria criterion for severe preeclampsia. The minimum threshold for diagnosing preeclampsia (with or without severe features) remains ≥0.3 g/24 h. Severity is now defined by end-organ involvement, not by the degree of proteinuria.
Clinical Pearl
A woman with new-onset hypertension and ≥0.3 g/24 h proteinuria meets criteria for preeclampsia. Severe features are determined by BP ≥160/110, thrombocytopenia, renal insufficiency, hepatic dysfunction, pulmonary edema, or neurological symptoms — not by a higher proteinuria cutoff.
Reference: ACOG Practice Bulletin No. 202, Gestational Hypertension and Preeclampsia, 2019 (reaffirming 2013 criteria); Williams Obstetrics, 25th edition.
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