Pre-eclampsia is a condition that usually develops late in pregnancy and is characterized by hypertension and proteinuria. Pre-eclampsia with severe features is additionally characterized by symptoms of end-organ damage which include headache, visual disturbances, altered mental status, blindness, dyspnea, edema, RUQ pain, and weakness/malaise. In this patient with pre-eclampsia with severe features, RUQ pain is the most likely of the above symptoms to be seen. The presence of tonic-clonic seizures defines eclampsia. Elevated blood glucose levels are seen due to gestational diabetes. Severe intractable nausea and vomiting is more characteristic of hyperemesis gravidarum.