A pregnant woman is presenting to the OPD at 35 weeks of gestation with severe facial and pedal edema. Her blood pressure is 160/110 mmHg, proteinuria is 3+ and serum creatinine is 1.8 mg/dL. She is complaining of headache, breathlessness, and epigastric pain. In which of the following categories would you classify her status?

1. A

   Gestational Hypertension

2. B

   Mild Preeclampsia

3. C

   Severe Preeclampsia

4. D

   Eclampsia

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

• The patient's condition is classified as severe preeclampsia based on the presence of hypertension with severe features.
• Her blood pressure of 160/110 mmHg meets the criterion for severe hypertension (systolic BP of 160 mmHg or greater, or diastolic BP of 110 mmHg or greater).
• She has significant proteinuria (3+), a key diagnostic marker for preeclampsia.
• Crucially, she exhibits multiple signs of end-organ damage, which define the disease as severe. These include:.
• Renal insufficiency, indicated by a serum creatinine level of 1.8 mg/dL (criterion is greater than 1.1 mg/dL).
• Central nervous system disturbances, indicated by her complaint of a headache.

Why Other Options Were Wrong

• Option A: Gestational hypertension is characterized by elevated blood pressure (greater than or equal to 140/90 mmHg) after 20 weeks of gestation without significant proteinuria. This patient has 3+ proteinuria, which excludes this diagnosis.
• Option B: Mild preeclampsia (or preeclampsia without severe features) involves hypertension (greater than or equal to 140/90 mmHg) and proteinuria, but lacks the signs of severe end-organ dysfunction. This patient's BP of 160/110 mmHg, high creatinine, headache, and epigastric pain are all 'severe features'.
• Option D: Eclampsia is the new onset of generalized, tonic-clonic seizures in a woman with preeclampsia. While this patient is at high risk for developing eclampsia, the diagnosis is not made until a seizure occurs. The scenario does not mention any seizure activity.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Diagnosis and classification of severe preeclampsia helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Severe preeclampsia is a life-threatening obstetric emergency. Prompt recognition and management are critical to prevent progression to eclampsia, HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), placental abruption, acute renal failure, and maternal or fetal death.
• Immediate nursing priorities include seizure prophylaxis with magnesium sulfate, controlling severe hypertension with IV antihypertensives (like labetalol or hydralazine), continuous maternal-fetal monitoring, and preparing for delivery, which is the only definitive cure.
• What if? - If this patient suddenly lost consciousness and started having a tonic-clonic seizure, the diagnosis would immediately become Eclampsia. The nurse's first action would be to call for help, ensure a patent airway, and protect the patient from injury (e.g., turning her to her side, raising bed rails). Administering the loading dose of IV magnesium sulfate would be the immediate medical priority to control the seizure.

How to Approach the Question

• First, analyze the patient's data provided in the clinical scenario: gestational age (35 weeks), blood pressure (160/110 mmHg), proteinuria (3+), serum creatinine (1.8 mg/dL), and subjective symptoms (headache, breathlessness, epigastric pain).
• Recall the definitions and diagnostic criteria for the different hypertensive disorders of pregnancy.
• Evaluate the options systematically. Gestational Hypertension is incorrect due to the presence of significant proteinuria.
• Differentiate between preeclampsia with and without severe features. The patient's BP is 160/110 mmHg (a severe feature), creatinine is greater than 1.1 mg/dL (renal insufficiency, a severe feature), and she has headache and epigastric pain (symptoms of end-organ damage, which are severe features). This rules out 'mild' preeclampsia.
• Consider Eclampsia. This diagnosis requires the presence of seizures, which are not mentioned in the scenario.
• Conclude that the patient's signs and symptoms align perfectly with the criteria for Severe Preeclampsia.

Concept Tested & Keywords

• Concept Tested: Diagnosis and classification of severe preeclampsia
• Stem keywords: pregnant, 35 weeks, edema, blood pressure 160/110 mmHg, proteinuria 3+, serum creatinine 1.8 mg/dL, headache, breathlessness
• Lead-in keywords: classify
• Clinical cues: BP of 160/110 mmHg is a key indicator of severe hypertension.
• Clinical cues: Serum creatinine of 1.8 mg/dL indicates renal insufficiency, a sign of end-organ damage.

Question ID

QAc0fhFA_P3rl2uTaLE_Wb

Copy ID

Reference Book

E6 Obstetrics Williams p. 2-9

E6 Medicine Harrison 22e Part 2 p. 1803-1805