ZyraDoc #43 - September 13, 2026

A 28-year-old primigravida at 34 weeks of gestation presents with a severe, persistent frontal headache, visual spot disturbances (scotomata), and persistent right upper quadrant abdominal pain.

Her blood pressure is elevated at 168/110 mmHg on two separate measurements taken 15 minutes apart, and urine dipstick reveals 3+ protein.

Laboratory evaluation demonstrates elevated liver enzymes (AST/ALT >120 U/L), a low platelet count (65,000/µL), and normal renal function, confirming preeclampsia with severe features.

Case Summary

Clinical Focus:

The diagnosis is Preeclampsia with Severe Features.

Aetiology/Cause:

Incomplete maternal spiral artery remodeling leading to placental hypoperfusion, localized ischemia, and release of anti-angiogenic factors into maternal circulation.
Widespread maternal vascular endothelial dysfunction and systemic arterial vasospasm developing after 20 weeks of gestation.
Multifactorial maternal risk factors including primigravidity, chronic hypertension, pre-gestational diabetes, high body mass index, and multifetal gestation.

Clinical Features:

Severe hypertension (systolic BP ≥160 mmHg or diastolic BP ≥110 mmHg) on two occasions at least 4 hours apart.
Central nervous system symptoms including persistent severe headache, visual scotomata, photophobia, altered mental status, or hyperreflexia with clonus.
Hepatic involvement manifesting as severe persistent right upper quadrant or epigastric pain due to liver capsule stretching or hepatic ischemia.
Hematologic derangements such as microangiopathic hemolytic anemia and severe thrombocytopenia (platelet count <100,000/µL).

Diagnosis and Investigations:

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