A 30-year-old primigravida at 32 weeks has BP 155/105 mmHg, 24-hour urinary protein 450 mg, and platelet count 85,000/μL with ALT 3× upper limit of normal. The most appropriate management is:

• A Expectant management with intensified surveillance until 34 weeks
• B Corticosteroids for fetal lung maturity followed by delivery after 48 hours ✓
• C Immediate delivery regardless of gestational age
• D Magnesium sulfate and antihypertensives with aim to continue pregnancy to 37 weeks

Explanation

This patient has severe features of pre-eclampsia with HELLP syndrome (platelets <100,000/μL, elevated liver enzymes). At 32 weeks, the standard management per ACOG guidelines is to administer antenatal corticosteroids (betamethasone) for fetal lung maturity and deliver after 48 hours if the maternal condition is stable. Delivery is the definitive treatment; expectant management beyond 48 hours post-steroids in HELLP is not safe. Continuing to 37 weeks is inappropriate given severe features.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.