A 32-year-old G3P2 woman at 35 weeks’ gestation has a past medical history significant for hypertension. She was well-controlled on hydrochlorothiazide and lisinopril as an outpatient, but these drugs were discontinued when she found out that she was pregnant. Her blood pressure has been relatively well controlled in the 120-130 mm Hg systolic range without medication, and urinalysis has consistently been negative for proteinuria at each of her prenatal visits. She presents now to the obstetric clinic with a blood pressure of 142/84 mm Hg. A 24-hour urine specimen yields 0.35 g of proteinuria.Which of the following is the most appropriate next step?
A 32-year-old G3P2 woman at 35 weeks’ gestation has a past medical history significant for hypertension. She was well-controlled on hydrochlorothiazide and lisinopril as an outpatient, but these drugs were discontinued when she found out that she was pregnant. Her blood pressure has been relatively well controlled in the 120-130 mm Hg systolic range without medication, and urinalysis has consistently been negative for proteinuria at each of her prenatal visits. She presents now to the obstetric clinic with a blood pressure of 142/84 mm Hg. A 24-hour urine specimen yields 0.35 g of proteinuria.Which of the following is the most appropriate next step?
💡 Explanation
## **Core Concept**
The patient presents with new-onset hypertension and proteinuria in the third trimester of pregnancy. This clinical scenario suggests the possibility of preeclampsia, a pregnancy complication characterized by **new-onset hypertension** and often accompanied by **proteinuria** after 20 weeks of gestation.
## **Why the Correct Answer is Right**
The correct approach involves assessing the severity of preeclampsia and considering the need for immediate delivery if severe features are present, or close monitoring and possible initiation of antihypertensive therapy if the condition is mild. Given that the patient's blood pressure is elevated (142/84 mm Hg) and there is proteinuria (0.35 g in 24 hours), but no mention of severe features (such as significantly elevated blood pressure, severe proteinuria, or symptoms like headache, visual disturbances, or severe abdominal pain), the most appropriate next step would typically involve **close monitoring** and possibly **initiation of antihypertensive therapy** to prevent progression to severe preeclampsia. The management might include labetalol or nifedipine for blood pressure control.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, incorrect options might suggest immediate delivery without assessment of severity, or failure to address the hypertension and proteinuria.
- **Option B:** Similarly, without specifics, an incorrect approach might involve not addressing the blood pressure adequately or ignoring the proteinuria.
- **Option D:** This option is also not detailed, but an incorrect approach could involve delaying intervention until the condition worsens or not following up closely.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **preeclampsia** is a leading cause of maternal and fetal morbidity and mortality worldwide. Early recognition and appropriate management are crucial. The American College of Obstetricians and Gynecologists (ACOG) provides guidelines for the diagnosis and management of preeclampsia, emphasizing the importance of blood pressure control and assessment for severe features.
## **Correct Answer:** .
✓ Correct Answer: D. Initial inpatient evaluation followed by restricted activity and outpatient management.
📤 Share this MCQ
Share Card Preview
👆 1080x1080 square card — fills the full width in WhatsApp and Telegram