A 24-year-old pregnant woman presents with pedal edema and a blood pressure of 160/110. What condition should you suspect?

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This question centers on recognizing a hypertensive disorder in pregnancy—preeclampsia. After 20 weeks of gestation, new high blood pressure with signs such as edema raises concern for preeclampsia, and a severe blood pressure like 160/110 indicates a higher risk of progression to complications, including seizures or organ dysfunction.

Edema is common in pregnancy, but when it accompanies markedly elevated blood pressure, especially in the severe range, preeclampsia becomes the most likely diagnosis. Preeclampsia can occur with or without proteinuria and may present with headaches, visual changes, right upper quadrant pain, or lab abnormalities signaling organ involvement.

Other conditions don’t fit as well. Gestational diabetes involves hyperglycemia symptoms and metabolic issues, not primarily hypertension with edema. Eclampsia is preeclampsia with seizures; since no seizures are described, the presentation is more consistent with preeclampsia without seizures. Placental abruption typically presents with sudden vaginal bleeding and uterine tenderness, not just edema and high blood pressure.

In the field, treat this as an obstetric emergency: ensure airway and breathing, position the patient on her side to optimize placental perfusion, monitor vitals, and arrange rapid transport to a facility capable of comprehensive obstetric care. Be alert for signs of progression to severe features or seizures and follow your protocol for seizure precautions and antihypertensive management as indicated.