A 27-year-old primigravida at 34 weeks has BP 152/100 mmHg on two occasions. Her 24-hour urine shows 420 mg of protein. She has no headache, visual change, or epigastric pain. Platelets are 210,000/uL, AST 28 U/L, creatinine 0.7 mg/dL, and fetal growth and Dopplers are normal. What is the best next step?
- A Expectant management with weekly laboratory and fetal surveillance until 37 weeks, then delivery ✓
- B Deliver by induction of labour now
- C Give a course of betamethasone and deliver immediately
- D Start magnesium sulfate for seizure prophylaxis and deliver at 34 weeks
Correct answer: A. Expectant management with weekly laboratory and fetal surveillance until 37 weeks, then delivery
Explanation
This is pre-eclampsia without severe features. With stable maternal disease and a normally grown fetus, expectant management prolongs pregnancy to 37 weeks, balancing neonatal maturity against maternal risk. Immediate delivery is reserved for severe features, fetal compromise, or gestational age of 37 weeks or more. Magnesium sulfate is indicated for severe disease or eclampsia, not for mild stable disease managed expectantly.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.