A G1P0 at 33 weeks presents with severe headache, blurred vision, and fatigue. BP 168/98, proteinuria +2, reflexes 4+, clonus present, edema, and intermittent epigastric pain. What is the diagnosis?

A G1P0 at 33 weeks presents with severe headache, blurred vision, and fatigue. BP 168/98, proteinuria +2, reflexes 4+, clonus present, edema, and intermittent epigastric pain. What is the diagnosis?

• A. Gestational diabetes
• B. Chronic hypertension
• C. Preeclampsia
• D. Eclampsia

Answer: (C)

New-onset hypertension after 20 weeks of gestation with proteinuria or signs of end-organ dysfunction is the hallmark of preeclampsia. In this case, at 33 weeks, there is markedly elevated blood pressure (168/98) with proteinuria (+2) and several features of end-organ involvement: severe headache and blurred vision (visual disturbances), hyperreflexia with clonus, edema, and intermittent epigastric pain suggesting hepatic involvement. This combination meets the criteria for preeclampsia with severe features. Eclampsia would require a seizure, which has not occurred here, so the diagnosis is preeclampsia with severe features. Gestational diabetes and chronic hypertension don’t fit this presentation—the former involves hyperglycemia, and the latter implies preexisting hypertension before 20 weeks. Delivery planning and seizure-prevention measures are critical next steps in management.

New-onset hypertension after 20 weeks of gestation with proteinuria or signs of end-organ dysfunction is the hallmark of preeclampsia. In this case, at 33 weeks, there is markedly elevated blood pressure (168/98) with proteinuria (+2) and several features of end-organ involvement: severe headache and blurred vision (visual disturbances), hyperreflexia with clonus, edema, and intermittent epigastric pain suggesting hepatic involvement. This combination meets the criteria for preeclampsia with severe features. Eclampsia would require a seizure, which has not occurred here, so the diagnosis is preeclampsia with severe features. Gestational diabetes and chronic hypertension don’t fit this presentation—the former involves hyperglycemia, and the latter implies preexisting hypertension before 20 weeks. Delivery planning and seizure-prevention measures are critical next steps in management.