A 32-year-old primigravida at 34 weeks gestation presents with blood pressure 160/110 mmHg, proteinuria 2+ on dipstick, and platelet count 95,000/μL. Which single clinical feature best distinguishes preeclampsia with severe features from gestational hypertension in this patient?

Question

Accepted Answer

D. Presence of proteinuria and thrombocytopenia. ## Distinguishing Preeclampsia from Gestational Hypertension

**Key Point:** The hallmark discriminator between preeclampsia (with severe features) and gestational hypertension is the presence of **end-organ dysfunction** — manifested as proteinuria, thrombocytopenia, elevated liver enzymes, or renal insufficiency. Gestational hypertension is hypertension *alone* without these systemic features.

### Comparison Table

| Feature | Gestational Hypertension | Preeclampsia (Severe Features) |
| --- | --- | --- |
| **BP threshold** | ≥140/90 mmHg after 20 wks | ≥160/110 mmHg (or ≥140/90 + end-organ signs) |
| **Proteinuria** | Absent | Present (≥1+ on dipstick or ≥0.3 g/24 h) |
| **Thrombocytopenia** | Absent | Present (<100,000/μL indicates severe features) |
| **Liver dysfunction** | Absent | May occur (elevated transaminases) |
| **Renal dysfunction** | Absent | May occur (Cr >1.1 mg/dL) |
| **Maternal/fetal risk** | Low | High |
| **Postpartum resolution** | By 12 weeks | By 12 weeks |

**High-Yield:** The presence of **any one** end-organ dysfunction sign (proteinuria, thrombocytopenia, elevated liver enzymes, renal insufficiency, pulmonary edema, cerebral symptoms) converts gestational hypertension to preeclampsia. In this case, the combination of proteinuria AND thrombocytopenia is pathognomonic for preeclampsia with severe features.

**Clinical Pearl:** A woman with BP 160/110 mmHg alone (without proteinuria or thrombocytopenia) would still be classified as gestational hypertension with severe range BP — the end-organ signs are what make it preeclampsia.

**Mnemonic: HELLP-P** — Hemolysis, Elevated Liver enzymes, Low Platelets, Proteinuria — these are the end-organ manifestations that distinguish preeclampsia from isolated hypertension.

Answer

A. Absence of hypertension before 20 weeks gestation

Answer

B. Nulliparity and third trimester presentation

Answer

C. Elevated blood pressure ≥160/110 mmHg

A 32-year-old primigravida at 34 weeks gestation presents with blood pressure 160/110 mmHg, proteinuria 2+ on dipstick, and platelet count 95,000/μL. Which single clinical feature best distinguishes preeclampsia with severe features from gestational hypertension in this patient?

Explanation

Distinguishing Preeclampsia from Gestational Hypertension

Comparison Table

Practice similar questions

Join our NEET PG community

Feature	Gestational Hypertension	Preeclampsia (Severe Features)
BP threshold	≥140/90 mmHg after 20 wks	≥160/110 mmHg (or ≥140/90 + end-organ signs)
Proteinuria	Absent	Present (≥1+ on dipstick or ≥0.3 g/24 h)
Thrombocytopenia	Absent	Present (<100,000/μL indicates severe features)
Liver dysfunction	Absent	May occur (elevated transaminases)
Renal dysfunction	Absent	May occur (Cr >1.1 mg/dL)
Maternal/fetal risk	Low	High
Postpartum resolution	By 12 weeks	By 12 weeks