A client with preeclampsia is monitored on the maternal-child unit. Which assessment finding most clearly indicates the condition is deteriorating?

• A. Blood pressure ranges between 198/102 and 170/92 mmHg in the past 8 hours.
• B. Urine dipstick reveals protein level of 3+.
• C. Liver function tests show elevation of all liver enzymes.
• D. Platelet counts decreasing from 120,000 to 108,000 to 98,000 per microliter.

Answer: (D)

A falling platelet count is the clearest sign that worsening preeclampsia is progressing toward serious complications like HELLP syndrome or DIC. Endothelial dysfunction in preeclampsia leads to increased platelet consumption in small clots, so a trend of platelets dropping from 120,000 to 98,000 per microliter shows active deterioration of the mother's coagulation status. While very high blood pressure, protein in the urine, and elevated liver enzymes indicate severe disease, they don’t demonstrate the same ongoing decline in hematologic stability. The downward trend in platelets signals a shift toward more dangerous systemic involvement, warranting urgent assessment and management.