A 28-year-old multiparous woman at 36 weeks gestation is found to have blood pressure 142/92 mmHg on two occasions 4 hours apart, with negative urine dipstick for protein and normal platelet count (250,000/μL). Which feature best distinguishes preeclampsia without severe features from preeclampsia with severe features in the context of pregnancy-induced hypertension?

Explanation

## Preeclampsia Without Severe Features vs. With Severe Features **Key Point:** The distinction between preeclampsia without severe features and preeclampsia with severe features hinges on the **absence of severe range BP AND absence of end-organ dysfunction**. This patient has preeclampsia (confirmed by hypertension + proteinuria or other signs), but without severe features because BP is not in severe range and there are no signs of end-organ involvement. ### Diagnostic Criteria Comparison | Criterion | Preeclampsia Without Severe Features | Preeclampsia With Severe Features | | --- | --- | --- | | **BP threshold** | ≥140/90 mmHg (but <160/110) | ≥160/110 mmHg OR ≥140/90 + end-organ sign | | **Proteinuria** | May be present or absent | May be present or absent | | **Thrombocytopenia** | Absent | Present (<100,000/μL) | | **Liver enzymes** | Normal | Elevated (AST/ALT >2× ULN) | | **Renal function** | Normal (Cr <1.1) | Elevated (Cr >1.1 or doubling) | | **Pulmonary edema** | Absent | Present | | **Cerebral symptoms** | Absent | Present (headache, visual changes) | | **Fetal findings** | May be normal | Often abnormal (FGR, oligohydramnios) | | **Delivery timing** | After 37 weeks (if stable) | Urgent delivery indicated | **High-Yield:** A patient with BP 142/92 mmHg (non-severe range) and normal labs (platelets, liver enzymes, renal function) has preeclampsia without severe features, even if proteinuria is present. The absence of severe range BP AND absence of end-organ dysfunction are the defining features. **Clinical Pearl:** Preeclampsia without severe features can be managed expectantly (with close monitoring) until 37 weeks if maternal and fetal condition remain stable. Preeclampsia with severe features requires urgent delivery regardless of gestational age (after corticosteroids if <34 weeks). **Mnemonic: SEVERE** — Systolic ≥160 OR End-organ signs (thrombocytopenia, liver dysfunction, renal insufficiency, pulmonary edema, eclampsia) — if either is present, it's severe.