A 25-year-old primigravida at 30 weeks gestation presents with blood pressure 156/104 mmHg on two occasions 4 hours apart, 3+ proteinuria on dipstick, persistent severe headache, and serum creatinine 1.2 mg/dL. Fetal biometry is appropriate for gestational age and the biophysical profile is 8/8. According to current evidence-based guidelines, what is the most appropriate management?

• A Immediate delivery by cesarean section regardless of gestational age
• B Expectant management until 37 weeks regardless of symptoms
• C Outpatient management with oral labetalol and weekly blood pressure monitoring
• D Expectant management with corticosteroids for fetal lung maturity, antihypertensives, and delivery at 34 weeks if stable ✓

Explanation

Severe pre-eclampsia before 34 weeks in a stable mother with a stable fetus warrants expectant management with corticosteroids for fetal lung maturity, antihypertensives, and close monitoring, with delivery at 34 weeks. Immediate delivery at 30 weeks is not indicated if both mother and fetus are stable. Outpatient management is contraindicated in severe pre-eclampsia. Expectant management beyond 34 weeks in severe pre-eclampsia increases maternal risk without fetal benefit.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.