A 17-year-old female is 28 weeks pregnant. She complains of severe swelling of her hands and feet. Vital signs are BP 160/100, P 108, R 24. What should you suspect?

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Multiple Choice

A 17-year-old female is 28 weeks pregnant. She complains of severe swelling of her hands and feet. Vital signs are BP 160/100, P 108, R 24. What should you suspect?

New-onset high blood pressure after mid-pregnancy with swelling in the hands and feet points to preeclampsia with severe features. At 28 weeks, the presence of edema plus a severe-range systolic blood pressure (160) fits the pattern of a hypertensive disorder of pregnancy. Preeclampsia is diagnosed when hypertension develops after 20 weeks and is accompanied by signs of end-organ involvement or, ideally, proteinuria; the severe threshold is typically a systolic of 160 or higher or a diastolic of 110 or higher, along with symptoms or labs indicating organ stress. Ectopic pregnancy, hyperemesis gravidarum, and placenta previa don’t align with this presentation: an ectopic pregnancy usually presents with abdominal pain and bleeding early in pregnancy; hyperemesis gravidarum presents with severe nausea/vomiting earlier on; placenta previa causes painless vaginal bleeding. So the combination here most strongly suggests preeclampsia, and this should prompt urgent obstetric evaluation and careful monitoring en route.

New-onset high blood pressure after mid-pregnancy with swelling in the hands and feet points to preeclampsia with severe features. At 28 weeks, the presence of edema plus a severe-range systolic blood pressure (160) fits the pattern of a hypertensive disorder of pregnancy. Preeclampsia is diagnosed when hypertension develops after 20 weeks and is accompanied by signs of end-organ involvement or, ideally, proteinuria; the severe threshold is typically a systolic of 160 or higher or a diastolic of 110 or higher, along with symptoms or labs indicating organ stress. Ectopic pregnancy, hyperemesis gravidarum, and placenta previa don’t align with this presentation: an ectopic pregnancy usually presents with abdominal pain and bleeding early in pregnancy; hyperemesis gravidarum presents with severe nausea/vomiting earlier on; placenta previa causes painless vaginal bleeding. So the combination here most strongly suggests preeclampsia, and this should prompt urgent obstetric evaluation and careful monitoring en route.

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