A 27-year-old primigravida at 31 weeks presents with an eclamptic seizure. She receives magnesium sulfate loading and her seizures stop. BP settles to 150/100 mmHg with labetalol. She is stable neurologically, cervix is unfavourable, and CTG is reassuring with adequate fetal growth. The most appropriate next step regarding delivery is:

• A Immediate emergency cesarean section because eclampsia mandates abdominal delivery
• B Continue magnesium sulfate for 24 hours and defer delivery until 37 weeks
• C Tocolysis with nifedipine for 48 hours to allow steroid completion before delivery
• D Plan delivery after maternal stabilisation, with induction of labour attempted unless obstetric contraindications exist ✓

Explanation

Eclampsia is an indication for delivery, but only after the mother is stabilised with control of seizures and blood pressure, which usually takes several hours. The route of delivery is decided purely by obstetric factors, and eclampsia itself is not an indication for cesarean section, so induction of labour is appropriate with a favourable or ripened cervix. Deferring to 37 weeks risks recurrent seizures, abruptio placentae, and intracranial haemorrhage, and tocolytics are contraindicated in severe disease at this gestation.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.