A 29-year-old G3P2 woman at 32 weeks gestation presents with headache, blurred vision, and upper abdominal pain. Her blood pressure is 168/110 mmHg on two readings 6 hours apart. Urinalysis shows 3+ proteinuria. Platelet count is 85,000/µL, AST is 210 U/L, and she reports right upper quadrant pain. The diagnosis and MOST important next step are:

• A Severe pre-eclampsia; admit and manage expectantly until 37 weeks
• B HELLP syndrome; administer dexamethasone and plan delivery after 48 hours
• C Gestational hypertension; start oral labetalol and monitor as outpatient
• D HELLP syndrome; administer magnesium sulphate, corticosteroids, and expedite delivery ✓

Explanation

The triad of microangiopathic haemolytic anaemia, elevated liver enzymes (AST >70 U/L), and low platelets (<100,000/µL) defines HELLP syndrome. Management includes magnesium sulphate for seizure prophylaxis, corticosteroids (betamethasone) for fetal lung maturity at 32 weeks, antihypertensive therapy, and expedited delivery is the definitive treatment once the fetus is viable and the condition is severe. Expectant management beyond stabilisation is not appropriate here.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.