Which of the following is a sign of severe preeclampsia?

Proteinuria of 4+ is a sign of severe preeclampsia. Preeclampsia is a condition that typically occurs after the 20th week of pregnancy and is characterized by hypertension and organ dysfunction, including kidney impairment, which is often indicated by significant levels of protein in the urine. In the case of severe preeclampsia, the presence of 4+ proteinuria reflects a marked and potentially dangerous level of protein excretion, suggesting significant renal compromise and an increased risk of maternal and fetal complications.

The other options, while they may occur during pregnancy, do not specifically indicate severe preeclampsia. Braxton Hicks contractions are normal, irregular contractions that do not signal labor and are not indicative of any disease state. Palpation of fetal movements is a normal finding during pregnancy and shows that the fetus is active and well. Fatigue is a common complaint among many pregnant women regardless of their blood pressure status and does not specifically relate to the severity of preeclampsia. Therefore, the presence of 4+ proteinuria is the most definitive indicator of severe preeclampsia among the choices provided.