A 24-year-old woman with 36 weeks of pregnancy, suddenly complains of headache and blurring of vision. Her B.P. is 170/110 mm of Hg. Urinary albumin is +++ and fundus examination shows areas of retinal hemorrhage. The line of further management would be:
**Question:** A 24-year-old woman with 36 weeks of pregnancy, suddenly complains of headache and blurring of vision. Her B.P. is 170/110 mm of Hg. Urinary albumin is +++ and fundus examination shows areas of retinal hemorrhage. The line of further management would be:
A. Observation
B. Antihypertensive therapy
C. Antenatal steroids
D. Delivery
**Correct Answer:** D. Delivery
**Core Concept:** Pre-eclampsia is a hypertensive disorder of pregnancy characterized by new-onset hypertension and characteristic features like proteinuria, neurological symptoms, and end-organ damage. It is a severe form of preeclampsia, which is a condition that affects pregnant women and is characterized by high blood pressure and proteinuria.
**Why the Correct Answer is Right:** Given the patient's symptoms (headache and blurred vision), hypertension (170/110 mmHg), severe proteinuria (+++), and fundus examination demonstrating areas of retinal hemorrhage, the correct management is delivery. This is because pre-eclampsia is a life-threatening condition that puts both the mother and the baby at risk. Delivery is necessary to prevent maternal and fetal complications, such as eclampsia (first-time seizures in pregnancy), HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), acute kidney injury, and intrauterine growth restriction.
**Why Each Wrong Option is Incorrect:**
A. Observation: While monitoring the patient is essential, delivery is the definitive treatment for pre-eclampsia, especially in severe cases like this.
B. Antihypertensive therapy: Although controlling blood pressure is important, it is not a definitive treatment for pre-eclampsia. Delivery is required to address the underlying pathology and protect the mother and the baby.
C. Antenatal steroids: Antenatal steroids are used to accelerate fetal lung maturation, which is beneficial for preterm infants. However, in this case, delivery is essential due to severe pre-eclampsia.
**Clinical Pearl:** Pre-eclampsia is a medical emergency and should be treated promptly to prevent severe maternal and fetal complications. In severe cases like this, the priority is to deliver the baby to address the underlying pathology and ensure maternal and fetal well-being.