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 **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.