A 25-year-old primigravida at 30 weeks with severe pre-eclampsia (BP 168/112 mmHg, platelets 88,000/µL) is being planned for expectant management in a tertiary care setting. She has received betamethasone for fetal lung maturity. Which of the following is an absolute indication to terminate expectant management and proceed to delivery?

• A Persistent severe headache despite analgesia and two antihypertensive agents ✓
• B Estimated fetal weight at 5th percentile on ultrasound
• C Serum creatinine rising from 0.9 to 1.1 mg/dL over 48 hours
• D Oligohydramnios with amniotic fluid index of 6 cm

Explanation

Persistent severe headache unresponsive to treatment indicates neurological involvement and is a criterion for severe features of pre-eclampsia, necessitating delivery. Other indications include eclampsia, pulmonary edema, DIC, abruption, or non-reassuring fetal status. Oligohydramnios and fetal growth restriction alone are not absolute indications for delivery at 30 weeks if maternal condition is stable. B creatinine of 1.1 mg/dL is borderline and not an absolute indication.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.