A woman at 32 weeks has severe pre-eclampsia with platelet count 85,000/µL, ALT 210 IU/L, and hemolytic anemia. She is stable. According to current FIGO/ACOG guidelines, the most appropriate management is:

• A Immediate delivery regardless of gestational age
• B Emergency cesarean section within 6 hours
• C Plasma exchange to correct microangiopathic hemolysis
• D Expectant management until 34 weeks with intensive maternal-fetal monitoring after corticosteroid administration ✓

Explanation

HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) at 32 weeks in a stable patient qualifies for expectant management until 34 weeks after administering antenatal corticosteroids for fetal lung maturation, provided there is no maternal or fetal compromise (no DIC, no hepatic rupture, no non-reassuring fetal status). Immediate delivery is indicated only if gestational age ≥34 weeks or if maternal/fetal deterioration occurs. Plasma exchange is not routine for HELLP.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.