A 29-year-old G2P1 at 31 weeks has BP 146/94 mmHg on two readings taken 6 hours apart. Repeat values over one week remain similar. Urine protein is absent on repeated testing, platelets, liver enzymes, and creatinine are normal, and she is asymptomatic. What is the best management?

• A Immediate delivery by caesarean section
• B Start low-dose aspirin and rebook her for antenatal care
• C Start methyldopa and plan delivery at 34 weeks
• D Expectant management with regular BP, laboratory, and fetal surveillance, with delivery at 37 weeks ✓

Explanation

She has gestational hypertension: BP of 140/90 mmHg or higher arising after 20 weeks without proteinuria or severe features. The fetus gains more than it risks from continued intrauterine life, so expectant management with surveillance is correct, with delivery at 37 weeks even if she remains uncomplicated. Aspirin is preventive and must begin in the first trimester to have benefit, so starting it now serves no purpose.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.