A 32-year-old primigravida at 34 weeks of gestation presents with blood pressure 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 assess maternal organ involvement?

Question

Accepted Answer

B. Serum creatinine and liver function tests. ## Diagnosis of Severe Preeclampsia: Role of Investigations

**Key Point:** Severe preeclampsia is defined by severe hypertension (≥160/110 mmHg) plus either proteinuria ≥3+ on dipstick OR clinical/laboratory evidence of end-organ dysfunction.

### Why Serum Creatinine and LFTs?

In a patient with clinical features of severe preeclampsia (BP ≥160/110, headache, epigastric pain, 3+ proteinuria), the next critical step is to assess **end-organ involvement**:

1. **Renal function** (serum creatinine, urea) — detects acute kidney injury
2. **Hepatic function** (AST, ALT, bilirubin) — detects HELLP syndrome or hepatic dysfunction
3. **Platelet count** — part of HELLP assessment

These investigations determine:
- Severity classification (severe vs. non-severe)
- Presence of severe features (oliguria, elevated transaminases, thrombocytopenia)
- Urgency of delivery

**Clinical Pearl:** Elevated liver enzymes (AST >70 IU/L) and low platelets (<100,000/μL) in the context of severe preeclampsia indicate HELLP syndrome — a medical emergency requiring immediate delivery.

### Why Not the Other Options?

| Investigation | Limitation in This Context |
|---|---|
| **24-hour urine protein** | Useful for diagnosis but takes 24 hours; diagnosis already established by 3+ dipstick proteinuria + severe BP + symptoms. Not urgent. |
| **Doppler ultrasound** | Assesses fetal well-being and placental insufficiency; does NOT assess maternal organ dysfunction. Secondary to maternal assessment. |
| **NST** | Fetal assessment tool; does not evaluate maternal end-organ involvement. |

**High-Yield:** In severe preeclampsia, maternal investigations (renal and hepatic function) take **priority** over fetal investigations because maternal safety determines management urgency.

**Mnemonic: HELLP** — Hemolysis, Elevated Liver enzymes, Low Platelets. Always check these three in severe preeclampsia.

Answer

A. 24-hour urine protein estimation

Answer

C. Non-stress test (NST)

Answer

D. Doppler ultrasound of umbilical artery

A 32-year-old primigravida at 34 weeks of gestation presents with blood pressure 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 assess maternal organ involvement?

Explanation

Diagnosis of Severe Preeclampsia: Role of Investigations

Why Serum Creatinine and LFTs?

Why Not the Other Options?

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Investigation	Limitation in This Context
24-hour urine protein	Useful for diagnosis but takes 24 hours; diagnosis already established by 3+ dipstick proteinuria + severe BP + symptoms. Not urgent.
Doppler ultrasound	Assesses fetal well-being and placental insufficiency; does NOT assess maternal organ dysfunction. Secondary to maternal assessment.
NST	Fetal assessment tool; does not evaluate maternal end-organ involvement.