A 30-year-old primigravida at 32 weeks gestation develops blood pressure of 158/104 mmHg, severe headache, and 3+ proteinuria. Her platelet count is 88,000/µL, AST is 140 IU/L, and serum creatinine is 1.4 mg/dL. The MOST appropriate immediate management is:

• A Expectant management with close monitoring until 37 weeks
• B Start oral labetalol and review in 24 hours
• C Administer magnesium sulfate loading dose and arrange delivery ✓
• D Perform amniocentesis for fetal lung maturity before decision

Explanation

This patient meets criteria for severe pre-eclampsia with HELLP syndrome features (thrombocytopenia, elevated transaminases, renal impairment). Magnesium sulfate is initiated for seizure prophylaxis and delivery is the definitive treatment regardless of gestational age once severe features are present. Expectant management is not appropriate beyond 34 weeks with severe features; betamethasone for lung maturity would be given concurrently but delivery planning must proceed immediately.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.