A primigravida at 32 weeks develops BP 155/105 mmHg with 2+ proteinuria. Platelet count is 82,000/μL, serum creatinine 1.3 mg/dL, and severe right upper quadrant pain. Which of the following interventions is MOST appropriate at this gestational age?

• A Expectant management with corticosteroids and magnesium sulfate, targeting delivery at 34 weeks
• B Administer betamethasone and plan delivery within 24–48 hours after corticosteroid benefit ✓
• C Immediate delivery regardless of fetal lung maturity due to HELLP syndrome
• D IV hydralazine bolus followed by oral nifedipine and discharge with weekly monitoring

Explanation

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) with severe features at 32 weeks requires corticosteroid administration for fetal lung maturity followed by delivery within 24–48 hours. Expectant management beyond 34 weeks is contraindicated in HELLP; delaying to 34 weeks risks maternal hepatic rupture. Immediate delivery without corticosteroids is suboptimal given 32-week prematurity when time permits steroid benefit. Discharge is unsafe with HELLP.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.