Hypertensive Disorders in Pregnancy (Pre-eclampsia, Eclampsia) MCQs

Obstetrics & Gynaecology · 183 free questions with answers & explanations.

1. A 26-year-old primigravida at 34 weeks of gestation presents with blood pressure of 156/104 mmHg on two readings 4 hours apart, and 2+ proteinuria on dipstick. She complains of epigastric pain and visual disturbances. Which of the following is the MOST appropriate next step in her management?
2. A 30-year-old woman at 32 weeks of gestation develops tonic-clonic seizures. She has had no prior prenatal care. On examination, BP is 170/110 mmHg and 3+ proteinuria is noted. After controlling the airway, which drug should be administered FIRST?
3. A 28-year-old primigravida at 36 weeks develops hypertension (148/96 mmHg on two occasions) with mild proteinuria but denies headache, visual symptoms, or epigastric pain. Laboratory tests including platelets, creatinine, and liver enzymes are all normal. Which of the following is the CORRECT diagnosis and management plan?
4. A patient with eclampsia is receiving magnesium sulfate infusion. She develops loss of deep tendon reflexes. Her respiratory rate is 10/min and urine output is 25 mL/hour. Which of the following is the MOST appropriate immediate action?
5. HELLP syndrome is a severe variant of pre-eclampsia. Which of the following laboratory combinations is DIAGNOSTIC of complete HELLP syndrome?
6. A 29-year-old primigravida at 34 weeks gestation has BP 158/106 mmHg, proteinuria 2+ on dipstick, and complains of epigastric pain. Platelet count is 88,000/µL, AST 210 IU/L, LDH 680 IU/L. Her serum creatinine is 1.3 mg/dL. Which of the following criteria BEST classifies this patient's condition?
7. In a patient with pre-eclampsia with severe features at 33 weeks, magnesium sulfate is being given for seizure prophylaxis. The infusion rate is 2 g/hour. Which clinical sign is the EARLIEST indicator of magnesium toxicity before respiratory depression occurs?
8. A 32-year-old woman with chronic hypertension conceives. At 22 weeks gestation, she develops proteinuria >300 mg/24 hours, which was absent at booking. Her blood pressure has risen from a baseline of 138/90 to 162/108 mmHg. What is the MOST appropriate diagnosis?
9. According to ACOG guidelines adopted in Williams Obstetrics 26th edition, which of the following is NOT a criterion for severe features of pre-eclampsia?
10. In the management of acute severe hypertension in a pregnant patient (BP 178/116 mmHg), which of the following antihypertensives has the most rapid onset of action and is used as FIRST-LINE in the acute setting?
11. A primigravida at 32 weeks develops BP 155/105 mmHg with 2+ proteinuria. Platelet count is 82,000/μL, serum creatinine 1.3 mg/dL, and severe right upper quadrant pain. Which of the following interventions is MOST appropriate at this gestational age?
12. The antihypertensive mechanism that makes labetalol preferred over pure beta-blockers in severe hypertension in pregnancy is best explained by:
13. In pre-eclampsia, the imbalance between sFlt-1 (soluble FMS-like tyrosine kinase-1) and PlGF (placental growth factor) leads to endothelial dysfunction primarily through which mechanism?
14. A 28-year-old eclamptic patient continues to have seizures despite two loading doses of magnesium sulfate. The urine output is 18 mL/hour. What is the NEXT best step?
15. The ASPRE trial established that low-dose aspirin started before 16 weeks reduces preterm pre-eclampsia risk by approximately what percentage in high-risk women identified by first-trimester combined screening?
16. A 30-year-old primigravida at 34 weeks presents with BP 158/106 mmHg, proteinuria 2+ on dipstick, and severe headache. Her platelet count is 88,000/µL, AST is 110 IU/L, and serum creatinine is 1.4 mg/dL. Which single criterion defines this as severe pre-eclampsia independent of her blood pressure level?
17. In the MAGPIE trial, magnesium sulfate was compared to placebo in pre-eclamptic women. The primary outcome demonstrated a reduction in which complication, forming the current evidence base for magnesium prophylaxis?
18. A pregnant woman on magnesium sulfate for severe pre-eclampsia becomes unresponsive, stops breathing, and her BP is 80/50 mmHg. Deep tendon reflexes are absent. Serum magnesium level is 12 mEq/L. What is the immediate management priority?
19. A patient with HELLP syndrome (Sibai's Class I) has platelets 48,000/µL at 28 weeks gestation. After 48 hours of betamethasone and stabilization, which decision best reflects current evidence?
20. Which antihypertensive is preferred for acute severe hypertension in pregnancy when IV access is unavailable, and what is its mechanism?
21. In the CHIPS (Control of Hypertension In Pregnancy Study) trial, tight control of non-severe hypertension in pregnancy (target diastolic 85 mmHg) compared to less-tight control (target diastolic 100 mmHg) resulted in which of the following?
22. A primigravida at 32 weeks presents with BP 158/105 mmHg, 2+ proteinuria, and serum sFlt-1/PlGF ratio of 85. According to current evidence and WHO guidelines, which intervention has the strongest evidence for improving maternal-fetal outcome in this scenario?
23. Which of the following correctly describes the mechanism by which elevated sFlt-1 causes endothelial dysfunction in pre-eclampsia?
24. According to ISSHP (International Society for the Study of Hypertension in Pregnancy) 2018 classification, which of the following is correctly classified as 'pre-existing hypertension with co-existent pre-eclampsia'?
25. A woman with eclampsia develops generalised tonic-clonic convulsions despite IV magnesium sulfate (loading dose given). Serum magnesium is 6 mEq/L. What is the MOST appropriate next step?
26. A 28-year-old primigravida at 32 weeks presents with BP 158/106 mmHg, proteinuria 2+ on dipstick, and severe headache. Platelet count is 78,000/µL, ALT 120 U/L, AST 110 U/L, and LDH 850 U/L. Which of the following best describes the mechanism by which sFlt-1 (soluble FMS-like tyrosine kinase-1) contributes to the endothelial dysfunction in this condition?
27. The MAGPIE trial (2002) established the role of magnesium sulfate in pre-eclampsia. Based on this trial, what is the number needed to treat (NNT) with magnesium sulfate to prevent one eclamptic seizure in women with pre-eclampsia?
28. A woman with severe pre-eclampsia at 34 weeks has an sFlt-1/PlGF ratio of 38. According to current ISSHP 2018 guidelines, which feature is considered a criterion for 'pre-eclampsia with severe features' that mandates delivery regardless of gestational age?
29. A 30-year-old primigravida with pre-eclampsia at 37 weeks develops sudden epigastric pain, nausea, and right shoulder tip pain. Labs show: platelets 68,000, AST 280 U/L, LDH 1800 U/L. She is hemodynamically stable. What is the most likely acute complication, and what is the pathogenesis?
30. The ASPRE trial evaluated the use of low-dose aspirin for prevention of preterm pre-eclampsia. At what gestational age should aspirin be initiated, and what is the recommended dose according to this trial protocol?
31. In the pathophysiology of pre-eclampsia, the imbalance between sFlt-1 (soluble FMS-like tyrosine kinase-1) and PlGF (placental growth factor) leads to which primary vascular effect?
32. The CHIPS (Control of Hypertension In Pregnancy Study) trial compared tight versus less-tight blood pressure control in non-severe hypertension in pregnancy. Which outcome was significantly different between the two groups?
33. A woman with severe pre-eclampsia at 34 weeks is on IV magnesium sulfate. She develops a respiratory rate of 10/min, loss of deep tendon reflexes, and oxygen saturation of 88%. The correct immediate management is:
34. According to ACOG 2020 guidelines, which antihypertensive drug is considered FIRST-LINE for acute severe hypertension in pregnancy and postpartum due to its rapid onset, predictable dose-response, and proven safety profile?
35. A primigravida at 37 weeks has BP 158/104 mmHg with headache. Urine protein/creatinine ratio is 0.32. She has thrombocytopenia (platelets 92,000), elevated AST (95 U/L), and serum creatinine 1.2 mg/dL. This constellation best represents:
36. The MAGPIE trial (2002) established magnesium sulfate as the standard anticonvulsant in pre-eclampsia. The primary mechanism by which magnesium sulfate prevents seizures in eclampsia is:
37. A 28-year-old primigravida at 34 weeks has BP 155/105 mmHg, proteinuria 2+, and thrombocytopenia (platelets 90,000/µL) with elevated AST. HELLP syndrome is diagnosed. According to the classification by Sibai (Tennessee classification), this patient would be classified as:
38. Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are angiogenic biomarkers used in predicting pre-eclampsia. The sFlt-1/PlGF ratio that best predicts short-term absence of pre-eclampsia within one week (rule-out) is:
39. In a patient with chronic hypertension on methyldopa who develops superimposed pre-eclampsia at 36 weeks with severe features, which antihypertensive is preferred for acute BP control given fetal considerations?
40. The ASPRE trial demonstrated that first-trimester combined screening (uterine artery Doppler, PAPP-A, MAP) followed by low-dose aspirin (150 mg nightly) from 11–14 weeks can reduce preterm pre-eclampsia (<37 weeks) by approximately what percentage?
41. In the CHIPS (Control of Hypertension in Pregnancy Study) trial, 'tight' blood pressure control (target diastolic 85 mmHg) compared to 'less tight' control (target 100 mmHg) in non-severe gestational hypertension was associated with which primary finding?
42. A 30-year-old primigravida at 28 weeks with pre-eclampsia undergoes placental pathology after delivery. Which finding is MOST characteristic of the uteroplacental insufficiency underlying severe early-onset pre-eclampsia?
43. A woman at 32 weeks has severe pre-eclampsia with platelet count 85,000/µL, ALT 210 IU/L, and hemolytic anemia. She is stable. According to current FIGO/ACOG guidelines, the most appropriate management is:
44. The angiogenic biomarker ratio most validated for predicting short-term risk of pre-eclampsia and guiding triage in suspected cases is:
45. A patient develops eclampsia with ongoing seizures despite two doses of IV magnesium sulfate (4g loading + 2g for breakthrough). The next most appropriate anticonvulsant to add is:
46. A 32-year-old primigravida at 34 weeks gestation presents with blood pressure of 158/106 mmHg, severe headache, and 4+ proteinuria. Platelet count is 82,000/μL, ALT 180 U/L, LDH 620 U/L, and the patient reports epigastric pain. Which of the following best describes the pathophysiology underlying the thrombocytopenia in this condition?
47. The MAGPIE trial established the role of magnesium sulfate in pre-eclampsia. Which of the following best describes its primary mechanism for preventing eclamptic seizures?
48. A 28-year-old woman at 30 weeks with severe pre-eclampsia has been stabilized on labetalol and magnesium sulfate. Repeat biophysical profile score is 6/10, umbilical artery Doppler shows absent end-diastolic flow (AEDF). According to current guidelines, the most appropriate management is:
49. In a patient with class II HELLP syndrome, which laboratory parameter combination defines this class according to the Mississippi Classification?
50. Which angiogenic biomarker ratio has the highest diagnostic accuracy for differentiating pre-eclampsia from other hypertensive disorders in pregnancy and is used clinically for 'rule-out' at >36 weeks gestation?
51. The HYPITAT trial (2009) compared induction of labour versus expectant management in women with gestational hypertension or mild pre-eclampsia at 36–41 weeks. The primary composite outcome of adverse maternal outcomes was significantly reduced in the induction group. Which of the following best describes the mechanism by which immediate delivery reduces maternal risk in near-term pre-eclampsia?
52. A 28-year-old primigravida at 32 weeks develops severe pre-eclampsia with headache, visual blurring, BP 168/112 mmHg, proteinuria 3+, and platelet count 95,000/µL. She is started on magnesium sulfate and labetalol. Six hours later, her ALT is 180 U/L, AST 210 U/L, LDH 920 U/L, and she develops right upper quadrant pain. Which of the following haematological parameters most reliably distinguishes HELLP syndrome from thrombotic thrombocytopenic purpura (TTP) in this setting?
53. According to the sFlt-1/PlGF ratio for prediction of pre-eclampsia, a ratio of ≤38 at 24–37 weeks is used to rule out pre-eclampsia in the short term. In a woman with a sFlt-1/PlGF ratio of 85 at 32 weeks with mild hypertension, what is the most appropriate management decision supported by current ACOG/ISSHP 2022 guidelines?
54. A woman with severe pre-eclampsia remote from term (28 weeks) is being managed expectantly at a tertiary centre. Which of the following neonatal benefits is the primary justification for attempting expectant management versus immediate delivery at this gestational age?
55. The Magpie Trial (2002) established magnesium sulfate as the drug of choice for eclampsia prevention. Compared to phenytoin and diazepam, which of the following best describes the proposed neuroprotective mechanism of magnesium in preventing eclamptic seizures?
56. A 28-year-old primigravida at 34 weeks presents with BP 160/110 mmHg, proteinuria 3+, and thrombocytopenia (platelets 85,000/µL). Serum LDH is 720 U/L, AST 110 U/L, and she complains of right upper quadrant pain. Which of the following best describes the mechanism by which antithrombin III (AT-III) levels are reduced in this condition?
57. The MAGPIE trial (2002) established magnesium sulfate as the drug of choice for eclampsia prophylaxis in women with pre-eclampsia. Which of the following outcomes was NOT demonstrated in MAGPIE?
58. A 32-year-old with severe pre-eclampsia at 36 weeks has a sFlt-1/PlGF ratio of 85. According to current biomarker-guided management guidelines, this ratio most accurately predicts which clinical outcome?
59. In the management of acute severe hypertension in pregnancy, a labetalol infusion is initiated. A woman develops bradycardia and hypotension despite dose reduction. Which receptor-binding profile of labetalol explains this adverse effect combination?
60. A pregnant woman at 30 weeks with severe pre-eclampsia is started on antenatal corticosteroids and a decision is made for expectant management. The HYPITAT trial evaluated this exact dilemma. Which of its key findings directly guides the gestational age threshold for delivery in pre-eclampsia?
61. A 32-year-old primigravida at 34 weeks gestation presents with BP 158/106 mmHg, proteinuria 3+, and serum uric acid of 7.8 mg/dL. She complains of epigastric pain and visual disturbances. Her platelet count is 88,000/mm³ and LDH is 780 IU/L. Which component of the sFlt-1/PlGF pathophysiology best explains the development of proteinuria in her condition?
62. According to the Magpie Trial, magnesium sulfate compared to phenytoin for seizure prophylaxis in women with severe pre-eclampsia showed which of the following outcomes?
63. A woman at 28 weeks gestation has BP 152/100 mmHg on two readings 6 hours apart with 24-hour urinary protein 350 mg. Her sFlt-1:PlGF ratio is 110. Under the FIGO 2018 first-trimester screening algorithm, which combination of biomarkers most accurately identifies women at high risk for early-onset pre-eclampsia (before 34 weeks)?
64. A patient with HELLP syndrome Class I (Mississipi classification) at 33 weeks is given dexamethasone. Which of the following correctly describes the rationale and evidence for corticosteroid use in HELLP syndrome?
65. In a woman with chronic hypertension who develops superimposed pre-eclampsia at 36 weeks, which feature MOST reliably distinguishes superimposed pre-eclampsia from worsening chronic hypertension alone?
66. A 32-year-old primigravida at 34 weeks presents with blood pressure 158/104 mmHg and proteinuria 2+ on dipstick. She denies headache, visual symptoms, or epigastric pain. Platelet count is 142,000/μL, ALT 38 U/L, and serum creatinine 0.9 mg/dL. Which criterion from the ISSHP 2018 classification best categorizes her condition as severe pre-eclampsia?
67. The ASPRE trial (2017) established that combined first-trimester screening followed by low-dose aspirin reduces early-onset preeclampsia by approximately what percentage in high-risk women?
68. In a patient with HELLP syndrome, which parameter in the Tennessee classification system distinguishes complete from partial (class 2) HELLP syndrome?
69. sFlt-1/PlGF ratio is used as a biomarker in suspected preeclampsia. According to current NICE 2023 guidance, a ratio below which threshold helps RULE OUT preeclampsia developing within the next 1 week in women presenting at 20–34+6 weeks with suspected preeclampsia?
70. A 28-year-old primigravida at 34 weeks gestation has BP 158/104 mmHg, proteinuria 2+ on dipstick, and new-onset headache. sFlt-1/PlGF ratio is measured at 85. Which of the following statements best characterises the pathophysiology of her condition?
71. The MAGPIE trial established magnesium sulphate as the standard of care for preventing eclampsia. What number-needed-to-treat (NNT) does the trial report for preventing one eclamptic seizure in women with pre-eclampsia?
72. A 32-year-old woman with pre-eclampsia with severe features at 36 weeks is on MgSO4 infusion. Her urine output has dropped to 12 mL/hour over the last 2 hours. Patellar reflexes are sluggish. Serum magnesium level is 9.5 mg/dL. What is the most appropriate immediate action?
73. In the context of HELLP syndrome, the class III (Tennessee classification) is distinguished from class I by which laboratory parameter threshold?
74. A pregnant woman at 28 weeks develops pre-eclampsia with severe features. Current ACOG guidance recommends initiating antihypertensive therapy when BP reaches which threshold?
75. The CHIPS (Control of Hypertension in Pregnancy Study) trial compared tight versus less-tight control of non-severe hypertension in pregnancy. The primary finding influencing current practice was:
76. Soluble fms-like tyrosine kinase-1 (sFlt-1) contributes to pre-eclampsia pathogenesis by binding and neutralising which two angiogenic factors, thereby causing widespread endothelial dysfunction?
77. A 30-year-old primigravida at 32 weeks has BP 155/105 mmHg, 24-hour urinary protein 450 mg, and platelet count 85,000/μL with ALT 3× upper limit of normal. The most appropriate management is:
78. In the sFlt-1:PlGF ratio-guided management of suspected pre-eclampsia, a ratio of ≤38 at 24–36+6 weeks gestation indicates:
79. Which mechanism best explains why low-dose aspirin (75–150 mg/day) initiated before 16 weeks reduces the risk of pre-eclampsia in high-risk women?
80. A 28-year-old primigravida at 32 weeks gestation presents with BP 158/102 mmHg, proteinuria 2.4 g/24h, and new-onset thrombocytopenia (platelets 92,000/µL). AST is elevated at 98 U/L. Which mechanism best explains the thrombocytopenia in this setting?
81. The CHIPS (Control of Hypertension in Pregnancy Study) trial compared tight control (target diastolic 85 mmHg) versus less tight control (target diastolic 100 mmHg) of non-severe hypertension in pregnancy. What was its primary conclusion?
82. A woman with pre-eclampsia at 36 weeks has a seizure despite adequate magnesium sulfate. The next appropriate step is:
83. Soluble fms-like tyrosine kinase-1 (sFlt-1) is elevated in pre-eclampsia. What is its primary pathogenic mechanism?
84. A pre-eclamptic patient at term is on magnesium sulfate infusion at 2 g/h. She develops reduced deep tendon reflexes and oliguria (15 mL/h). Serum magnesium level is 9.2 mg/dL. The most appropriate immediate action is:
85. A 32-year-old primigravida at 32 weeks presents with BP 158/106 mmHg, proteinuria 3.4 g/24 hours, and platelet count 78,000/µL. LDH is 720 IU/L, AST 95 IU/L, and peripheral smear shows schistocytes. Which of the following pathophysiological mechanisms BEST explains the thrombocytopenia in this condition?
86. The MAGPIE trial established the role of magnesium sulfate in pre-eclampsia. The trial demonstrated that magnesium sulfate reduced eclampsia risk by approximately what percentage compared to placebo, and what was the Number Needed to Treat (NNT) to prevent one case of eclampsia?
87. A woman with severe pre-eclampsia at 34 weeks develops oliguria (25 mL/hour) after receiving IV magnesium sulfate. Serum magnesium level is 9.2 mg/dL. Which early sign of magnesium toxicity is FIRST lost at approximately this serum level?
88. According to ISSHP (International Society for the Study of Hypertension in Pregnancy) 2018 classification, which of the following is a CORRECT criterion distinguishing pre-eclampsia from gestational hypertension, even in the ABSENCE of proteinuria?
89. A primigravida at 12 weeks gestation is identified as high-risk for pre-eclampsia based on uterine artery Doppler pulsatility index, PAPP-A, and mean arterial pressure. What is the MOST evidence-based intervention to reduce her risk of early-onset pre-eclampsia?
90. A 29-year-old primigravida at 32 weeks gestation presents with BP 158/106 mmHg, 3+ proteinuria, and severe headache. Platelet count is 92,000/µL, AST 110 U/L, serum creatinine 1.4 mg/dL. Which combination of findings best defines 'severe features' of pre-eclampsia in this patient?
91. A 26-year-old with pre-eclampsia with severe features at 34 weeks is on magnesium sulfate. She develops decreased deep tendon reflexes, respiratory rate drops to 10/min, and urine output falls to 15 mL/hour. The immediate antidote and correct dose is:
92. In a patient with eclampsia who has received a 4 g loading dose of magnesium sulfate IV and has a second convulsion 20 minutes later, the recommended immediate management per Pritchard's protocol is:
93. A 32-year-old with gestational hypertension at 36 weeks has BP 155/100 mmHg. She has no proteinuria and no severe features. Which antihypertensive is the drug of first choice for acute BP control in this situation?
94. A woman with severe pre-eclampsia at 28 weeks is being managed expectantly. The sFlt-1/PlGF ratio on serum testing is 85. Which statement about this biomarker is correct?
95. A 28-year-old primigravida at 34 weeks presents with BP 158/106 mmHg, headache, and 2+ proteinuria. Platelet count is 92,000/µL, AST 110 U/L, and serum creatinine 1.3 mg/dL. She has no visual symptoms. Which single criterion BEST categorises this as severe pre-eclampsia by ACOG 2023 criteria?
96. In the HYPITAT trial, induction of labour at 37 weeks in women with gestational hypertension or mild pre-eclampsia compared to expectant management resulted in:
97. A 32-year-old woman with pre-eclampsia with severe features at 36 weeks is started on IV labetalol and magnesium sulfate. Two hours later she becomes oliguric (urine output 15 mL/hr) and her serum magnesium level is 8.5 mEq/L. Her patellar reflexes are absent. The IMMEDIATE next step is:
98. Regarding the sFlt-1/PlGF ratio in pre-eclampsia prediction, a ratio > 38 before 34 weeks gestation has which clinical utility according to PROGNOSIS study data?
99. A 30-year-old primigravida at 34 weeks presents with BP 158/104 mmHg, proteinuria 2+, and platelet count 85,000/µL with elevated LDH. Which of the following criteria is MOST consistent with the current ACOG (2013 revised) definition of severe features of pre-eclampsia?
100. A woman with established HELLP syndrome at 32 weeks gestation has received antenatal corticosteroids. At what platelet count threshold should platelet transfusion be given BEFORE cesarean delivery?
101. The ASPRE trial evaluated which intervention for prevention of pre-eclampsia in screen-positive women (based on first-trimester combined screening)?
102. A 30-year-old primigravida at 34 weeks presents with BP 158/106 mmHg, 2+ proteinuria, and severe headache. Platelets are 88,000/µL, AST 210 U/L, and serum creatinine 1.4 mg/dL. Which single feature places her in the 'severe features' category of preeclampsia according to current ACOG classification?
103. In the MAGPIE trial, magnesium sulfate was compared to placebo in women with preeclampsia. The primary finding was that magnesium sulfate reduced the risk of which of the following outcomes by approximately 58%?
104. A woman with severe preeclampsia at 32 weeks is being managed expectantly. Her cervix is unfavorable. Uterine artery Doppler shows bilateral notching with PI >95th centile. Fetal growth is on the 8th centile. Which additional Doppler finding would be the strongest indication to deliver immediately regardless of gestational age?
105. A 28-year-old primigravida at 26 weeks develops HELLP syndrome. Her platelet count is 62,000/µL, LDH 1,100 U/L, AST 180 U/L. She is hemodynamically stable with no fetal compromise. According to Mississippi classification of HELLP, she belongs to which class?
106. The MAGPIE trial conclusively demonstrated that magnesium sulphate, compared to placebo, in women with pre-eclampsia reduces the risk of which of the following outcomes?
107. A 28-year-old primigravida at 37 weeks gestation has severe pre-eclampsia with BP 160/110 mmHg, headache, and proteinuria 3+. According to the HYPITAT trial findings, the most appropriate management strategy is:
108. In HELLP syndrome, which of the following laboratory criteria most specifically defines 'microangiopathic haemolytic anaemia' on peripheral smear?
109. A woman with severe pre-eclampsia at 28 weeks is managed with magnesium sulphate and labetalol. She develops oliguria (urine output 15 mL/hr for 3 hours) and serum creatinine rises to 1.2 mg/dL. The next most appropriate step is:
110. Regarding placental growth factor (PlGF) testing in suspected pre-eclampsia before 35 weeks, a PlGF result below which threshold is used to 'rule in' significant placental dysfunction according to the PARROT trial?
111. A 28-year-old primigravida at 34 weeks develops BP 158/106 mmHg, proteinuria 3+, and serum creatinine 1.4 mg/dL. Platelet count is 68,000/mm³ and LDH is 720 U/L. Which feature specifically identifies HELLP syndrome as a complication of severe pre-eclampsia in this patient?
112. In the Tennessee classification of HELLP syndrome, a patient with platelet count 68,000/mm³, LDH 680 U/L, and AST 90 U/L belongs to which class?
113. A 32-year-old primigravida with severe pre-eclampsia at 30 weeks is started on IV labetalol. Which antihypertensive is CONTRAINDICATED in pregnancy when used as oral maintenance therapy beyond 20 weeks?
114. According to current ACOG guidance, which serum biomarker ratio is used to rule-out pre-eclampsia within the next 1 week in women presenting with hypertension between 20–35 weeks gestation?
115. A 30-year-old primigravida at 34 weeks presents with BP 158/106 mmHg, proteinuria 2+, and platelet count of 88,000/µL with serum AST 92 IU/L and LDH 720 IU/L. She has no headache or visual symptoms. Which feature in this patient definitionally qualifies her as having severe pre-eclampsia under ACOG 2013 criteria?
116. A 28-year-old woman at 36 weeks gestation with pre-eclampsia with severe features is started on magnesium sulfate. Two hours later she becomes areflexic with a respiratory rate of 10/min. Serum magnesium level is 9 mg/dL. What is the IMMEDIATE treatment?
117. Which of the following antihypertensive drugs is the FIRST-LINE agent recommended for acute severe hypertension (BP ≥160/110 mmHg) in a pregnant woman with a documented penicillin allergy and no contraindications to oral therapy?
118. The CHIPS trial (Control of Hypertension in Pregnancy Study) compared 'less tight' (target diastolic 100 mmHg) versus 'tight' (target diastolic 85 mmHg) control of non-severe chronic or gestational hypertension in pregnancy. Which was the PRIMARY finding of this trial?
119. A 32-year-old woman at 38 weeks develops eclampsia. After controlling seizures with magnesium sulfate, her cervix is 4 cm dilated, 70% effaced, cephalic presentation at -1 station with a reactive CTG. What is the most appropriate management?
120. A 32-year-old primigravida at 32 weeks develops BP 158/106 mmHg, headache, and 24-hour urinary protein of 450 mg. Serum creatinine is 1.3 mg/dL and platelet count is 88,000/µL. Serum AST is 145 IU/L. Which single feature places this case in the 'severe features' category that is NOT merely elevated BP?
121. The CHIPS (Control of Hypertension in Pregnancy Study) trial compared 'tight' (target diastolic 85 mmHg) versus 'less-tight' (target diastolic 100 mmHg) control in non-severe hypertension in pregnancy. The primary finding was:
122. In a patient with HELLP syndrome at 28 weeks gestation, which intervention has the strongest evidence for prolonging pregnancy and improving perinatal outcome?
123. A 32-year-old primigravida at 34 weeks presents with headache, visual disturbances, BP 160/110 mmHg, proteinuria 4+ on dipstick, and serum creatinine 1.3 mg/dL. She has no prior seizures. Which feature BEST qualifies this as severe preeclampsia warranting immediate delivery consideration?
124. The MAGPIE trial established the role of magnesium sulphate in preeclampsia. Which conclusion was its primary finding?
125. A 28-year-old woman presents at 20 weeks with BP 150/100 mmHg. Her BP was normal at booking at 10 weeks. Urinalysis shows no protein. Platelet count is 180,000/µL. What is the MOST likely diagnosis?
126. Which antihypertensive agent is CONTRAINDICATED in pregnancy due to risk of fetal renal tubular dysplasia and oligohydramnios when used after the first trimester?
127. The CHIPS (Control of Hypertension in Pregnancy Study) trial compared tight versus less-tight blood pressure control in pregnant women with chronic or gestational hypertension. Its main finding was:
128. HELLP syndrome is best classified using the Mississippi classification. Class 1 HELLP is defined by which platelet count threshold?
129. A 28-year-old primigravida at 32 weeks develops BP 158/104 mmHg, proteinuria 2+ on dipstick, and serum creatinine 1.3 mg/dL. Which additional laboratory finding would most specifically indicate haematological involvement warranting immediate delivery consideration?
130. In a patient with severe pre-eclampsia receiving magnesium sulphate infusion, the first clinical sign of magnesium toxicity to disappear is:
131. The CHIPS (Control of Hypertension in Pregnancy Study) trial demonstrated that compared to 'less tight' control, 'tight' control of non-severe hypertension in pregnancy to a target diastolic of 85 mmHg:
132. A woman with eclampsia at 30 weeks is stabilised on magnesium sulphate. She has a persisting BP of 170/115 mmHg despite two doses of IV hydralazine 5 mg each. The next drug of choice for acute BP control in this scenario is:
133. A 28-year-old primigravida at 34 weeks develops BP 158/105 mmHg, urine protein 3+ on dipstick, and platelet count of 88,000/µL. Serum AST is 112 U/L. Which criterion distinguishes her diagnosis from uncomplicated severe pre-eclampsia?
134. In the MAGPIE trial, magnesium sulfate was shown to reduce the risk of which outcome compared with placebo in women with pre-eclampsia?
135. A woman with severe pre-eclampsia at 30 weeks is being managed expectantly. Which finding on Doppler velocimetry indicates the most severe fetal compromise mandating delivery regardless of gestational age?
136. A 30-year-old primigravida at 32 weeks presents with BP 158/106 mmHg, proteinuria 3+ on dipstick, and serum creatinine 1.4 mg/dL. She has no symptoms. Which feature BEST classifies this as severe pre-eclampsia rather than non-severe?
137. The MAGPIE trial established the role of magnesium sulfate in eclampsia prevention. Which conclusion from this landmark RCT was most significant?
138. A woman with HELLP syndrome at 34 weeks has platelets 48,000/µL, LDH 820 U/L, and AST 110 U/L. According to the Mississippi classification, she is in which class?
139. Low-dose aspirin for pre-eclampsia prevention is most effective when started at which gestational age, based on current evidence including the ASPRE trial?
140. Regarding the first-trimester combined screening for pre-eclampsia (FMF algorithm), which combination of markers provides the BEST detection rate at 11–13 weeks?
141. Angiogenic markers in pre-eclampsia show which characteristic pattern in the weeks preceding clinical onset?
142. The MAGPIE trial established which of the following regarding magnesium sulphate in pre-eclampsia?
143. A 28-year-old primigravida at 34 weeks has BP 158/106 mmHg on two readings 4 hours apart, with 2+ proteinuria. She has no symptoms. The HYPITAT trial evidence supports which initial management strategy?
144. Which of the following features qualifies a hypertensive pregnant woman for the diagnosis of pre-eclampsia with severe features according to current ACOG criteria, even without severe hypertension (≥160/110)?
145. A 32-year-old G2P1 at 30 weeks presents with BP 170/112, epigastric pain, AST 120 U/L, platelet count 88,000/μL, and haemoglobin 9.2 g/dL. Peripheral smear shows schistocytes. Which named syndrome does this represent and what is the definitive treatment?
146. Low-dose aspirin (60–150 mg/day) started before 16 weeks gestation reduces the risk of pre-eclampsia primarily by which mechanism?
147. A 30-year-old primigravida at 32 weeks gestation develops blood pressure of 158/104 mmHg, severe headache, and 3+ proteinuria. Her platelet count is 88,000/µL, AST is 140 IU/L, and serum creatinine is 1.4 mg/dL. The MOST appropriate immediate management is:
148. The PREVENT trial evaluated aspirin for pre-eclampsia prevention. According to this and related evidence, the recommended aspirin dose and timing of initiation for high-risk women is:
149. In a woman with HELLP syndrome, which of the following is the MOST reliable laboratory indicator of disease severity and risk of adverse maternal outcome?
150. A multiparous woman develops grand mal seizure at 36 weeks gestation. Magnesium sulfate is administered. Six hours later she becomes oliguric with urine output of 15 mL/hour. Her serum magnesium level is 9 mEq/L. The FIRST intervention should be:
151. First-trimester prediction of pre-eclampsia using the Fetal Medicine Foundation (FMF) combined screening model incorporates which combination of markers?
152. Differential diagnosis of thrombocytopenia in pregnancy includes HELLP syndrome, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), and gestational thrombocytopenia. Which feature MOST strongly distinguishes TTP from HELLP syndrome?
153. Magnesium sulfate regimen for seizure prophylaxis and treatment in eclampsia — the Pritchard regimen involves:
154. A 28-year-old primigravida at 34 weeks presents with blood pressure of 156/106 mmHg on two readings 4 hours apart, proteinuria 2+ on dipstick, and platelet count of 88,000/µL. Serum AST is 98 IU/L. Which FIGO/ISSHP criterion confirms severe pre-eclampsia in this patient?
155. The sFlt-1 to PlGF ratio is used in predicting pre-eclampsia. Which of the following best describes its role in clinical practice?
156. A woman develops eclamptic convulsions at 32 weeks. After controlling seizures with magnesium sulfate, her BP remains 160/110 mmHg despite labetalol 20 mg IV twice. What is the next best antihypertensive agent?
157. The Magpie trial established which of the following regarding magnesium sulfate in pre-eclampsia?
158. A multiparous woman at 36+2 weeks develops HELLP syndrome (platelets 62,000/µL, AST 220 IU/L, LDH 890 IU/L). Blood pressure is 148/96 mmHg with no severe symptoms. What is the most appropriate management?
159. A 32-year-old primigravida at 34 weeks develops severe hypertension (BP 170/115 mmHg), proteinuria 3+, and serum creatinine 1.4 mg/dL. LFTs are normal and platelet count is 98,000/µL. Which feature MOST clearly upgrades this to severe pre-eclampsia according to ACOG 2019 criteria?
160. In a patient with HELLP syndrome, the Stanford classification uses LDH, AST and platelet count. Which laboratory finding correctly identifies Class 1 (most severe) HELLP by the Tennessee classification?
161. A 29-year-old primigravida at 28 weeks presents with BP 155/105 mmHg. sFlt-1:PlGF ratio is requested. Which ratio value best identifies a woman who is UNLIKELY to develop pre-eclampsia within 4 weeks according to current evidence?
162. Aspirin prophylaxis for pre-eclampsia is recommended by ACOG to be started at which gestational age window in high-risk women?
163. A 30-year-old primigravida at 34 weeks presents with BP 160/110 mmHg, severe headache, and serum creatinine 1.3 mg/dL. Her 24-hour urine protein is 3.8 g. She has platelet count 82,000/mm³ and elevated LFTs. Which feature BEST identifies this as severe pre-eclampsia rather than HELLP syndrome?
164. A patient with severe pre-eclampsia at 32 weeks is stabilised with MgSO₄. Four hours later she becomes areflexic with a respiratory rate of 10/min. The next immediate step is:
165. Which uteroplacental finding on Doppler velocimetry is MOST predictive of imminent fetal compromise in early-onset severe pre-eclampsia before 34 weeks?
166. A 28-year-old woman develops eclamptic convulsion at 37 weeks. After controlling seizures with MgSO₄, her BP remains 155/100 mmHg on labetalol. The mode and timing of delivery recommended by current Indian guidelines (FOGSI/WHO) is:
167. Low-dose aspirin prophylaxis for pre-eclampsia is MOST effective when initiated at:
168. A 30-year-old primigravida at 34 weeks presents with BP 158/108 mmHg on two occasions 4 hours apart. Her platelet count is 88,000/µL, AST is 98 U/L, and she complains of severe epigastric pain. Which component of the HELLP syndrome is she MISSING to fulfill the complete laboratory triad?
169. A 28-year-old woman at 32 weeks develops severe pre-eclampsia with BP 168/112 mmHg. After initial stabilization with intravenous labetalol, which drug is the FIRST-LINE anticonvulsant for prophylaxis and treatment of eclamptic seizures in this patient?
170. In the Magpie Trial (2002), magnesium sulfate was compared to placebo in women with pre-eclampsia. What was the primary finding regarding eclampsia prevention?
171. A woman with severe pre-eclampsia at 28 weeks receives antenatal corticosteroids and magnesium sulfate. Her magnesium level returns as 9.5 mEq/L. Which clinical finding is MOST LIKELY to be present at this level?
172. Which of the following best describes 'severe features' of pre-eclampsia according to ACOG criteria that would mandate delivery regardless of gestational age?
173. A 30-year-old primigravida at 36 weeks presents with BP 158/104 mmHg, proteinuria 2+ on dipstick, and severe epigastric pain with right upper quadrant tenderness. Platelets are 88,000/µL and AST is 210 U/L. Which diagnostic label best fits her condition?
174. Which of the following antihypertensives is absolutely contraindicated in pregnancy because of fetal renal tubular dysplasia and oligohydramnios?
175. A woman with severe pre-eclampsia at 34 weeks is started on magnesium sulphate. Four hours later she has absent deep tendon reflexes but is still conscious and breathing. Her urinary output in the last hour is 15 mL. What is the most appropriate immediate action?
176. The ASPRE trial demonstrated that first-trimester combined screening (maternal factors + uterine artery Doppler + PlGF + PAPP-A) with low-dose aspirin (150 mg/night) from 11–14 weeks reduced the risk of:
177. Magnesium sulphate is the drug of choice for prevention of eclamptic seizures. In a woman receiving MgSO4, which clinical sign indicates early magnesium toxicity that should prompt dose reduction?
178. In acute severe hypertension in pregnancy (systolic ≥ 160 or diastolic ≥ 110 mmHg), which medication is the FIRST-LINE treatment per ACOG 2022 guidance?
179. sFlt-1/PlGF ratio is used as a biomarker in pre-eclampsia prediction. A value of sFlt-1/PlGF ≤38 at 24–37 weeks has what clinical significance?
180. Low-dose aspirin (75–150 mg/day) for pre-eclampsia prevention is most effective when started at what gestational age for women with high-risk features?
181. The Magpie Trial (2002) demonstrated the efficacy of magnesium sulphate for which purpose in women with pre-eclampsia?
182. The ASPRE trial (2017) validated the use of first-trimester combined screening (maternal factors + uterine artery Doppler + PlGF + MAP) to predict pre-eclampsia and evaluated aspirin prophylaxis. The trial found that aspirin 150 mg daily given to high-risk women from 11–14 weeks onwards reduced the rate of preterm pre-eclampsia by approximately:
183. A 29-year-old primigravida at 36 weeks develops sudden-onset tonic-clonic convulsions preceded by headache and visual disturbances. BP is 170/112 mmHg. The patient is managed with magnesium sulphate (loading dose 4 g IV over 15 minutes). The maintenance infusion of MgSO₄ is 1 g/hour IV. Six hours later, the patient develops loss of deep tendon reflexes (DTR). The first sign of magnesium toxicity and the antidote are: