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Pulmonary edema is a recognized complication of severe preeclampsia due to capillary leak and fluid overload. Endothelial dysfunction increases vascular permeability, and aggressive fluid resuscitation or cardiac dysfunction can precipitate pulmonary edema. It presents with dyspnea, hypoxia, and crackles on auscultation.

Acute renal failure occurs due to renal vasoconstriction and glomerular endotheliosis. Preeclampsia reduces renal perfusion and glomerular filtration rate. Serum creatinine rises above 1.1 mg/dL or doubles from baseline. Oliguria <500 mL/day may be seen. Renal biopsy shows swollen glomeruli and fibrin deposition.

Cerebral hemorrhage results from severe hypertension and vascular rupture. Systolic pressures >160 mmHg increase risk of intracranial bleeding. Neurological signs include headache, visual disturbances, seizures, and altered consciousness. CT scan confirms hemorrhage. It is a leading cause of maternal death in eclampsia.

Visual disturbances such as scotomata or blurred vision indicate cerebral involvement due to vasospasm or cerebral edema. These are warning signs of impending eclampsia and require urgent evaluation. They reflect central nervous system irritation and are part of diagnostic criteria for severe preeclampsia.

Epigastric pain is caused by hepatic capsule distension due to periportal hemorrhage or subcapsular hematoma. It reflects liver involvement and is often associated with elevated transaminases. This symptom may precede HELLP syndrome and is a red flag for disease progression.

Oliguria, defined as urine output <500 mL/day, results from renal vasoconstriction and glomerular endotheliosis. It indicates reduced renal perfusion and is a marker of severe disease. Serum creatinine may rise, and fluid balance must be closely monitored.

Intrauterine growth restriction (IUGR) results from chronic placental hypoperfusion and nutrient deprivation. Hypertensive disorders impair trophoblastic invasion and spiral artery remodeling, reducing placental blood flow. Fetal abdominal circumference and estimated weight fall below the 10th percentile.

Preterm birth is common due to iatrogenic delivery for maternal or fetal indications. Severe preeclampsia or eclampsia may necessitate early termination to prevent maternal complications. Spontaneous preterm labor may also occur due to placental inflammation or abruption.

Fetal hypoxia occurs due to reduced oxygen delivery from impaired uteroplacental circulation. Chronic hypoxia leads to abnormal fetal heart rate patterns, meconium-stained amniotic fluid, and low Apgar scores. Doppler velocimetry may show absent or reversed end-diastolic flow.