A woman with severe pre-eclampsia at 28 weeks is managed with magnesium sulphate and labetalol. She develops oliguria (urine output 15 mL/hr for 3 hours) and serum creatinine rises to 1.2 mg/dL. The next most appropriate step is:
- A Careful fluid challenge of 300 mL crystalloid over 20 minutes, monitoring for pulmonary oedema ✓
- B Fluid bolus of 500 mL normal saline and reassess
- C Start frusemide infusion immediately
- D Immediate haemodialysis
Correct answer: A. Careful fluid challenge of 300 mL crystalloid over 20 minutes, monitoring for pulmonary oedema
Explanation
Oliguria in severe pre-eclampsia may reflect reduced renal perfusion (prerenal) or intrinsic renal dysfunction. The initial approach is a cautious fluid challenge (typically 250–300 mL crystalloid) while monitoring closely for pulmonary oedema, which is a major complication of fluid overloading in pre-eclampsia due to reduced oncotic pressure and increased capillary permeability. A 500 mL bolus risks pulmonary oedema; frusemide worsens volume depletion; haemodialysis is premature at this stage.
Reference: Williams Obstetrics, 26th ed.
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