A 16-year-old primigravida at 36 weeks with gestational hypertension has mild proteinuria and edema. Which statement would most indicate worsening gestational hypertension?

• A. The swelling in hands and ankles has gone down.
• B. My vision for the past 2 days has been really fuzzy.
• C. I had heartburn yesterday after spicy foods.
• D. I had a headache yesterday, but acetaminophen helped.

Answer: (B)

Blurred vision signals end‑organ involvement from preeclampsia. When gestational hypertension progresses, signs like visual disturbances indicate cerebral or retinal involvement due to severe vasospasm and endothelial dysfunction, signaling a need for urgent evaluation and potential escalation of care.

Swelling that has decreased would mean improvement, not worsening. A heartburn episode after spicy food is common and not a reliable indicator of disease progression. A recent headache that responded to acetaminophen could be benign or mild; in preeclampsia, a persistent or severe headache, especially if not relieved, would raise concern, but the clear red flag here is the visual change. If vision becomes fuzzy, seek immediate medical attention for maternal and fetal assessment.