Medical Disorders in Pregnancy · NEET PG Preparation Obstetrics & Gynaecology
A 28-year-old primigravida at 34 weeks of gestation presents with a 2-day history of severe right upper quadrant pain, nausea, and vomiting. Laborato…
Practice question from Medical Disorders in Pregnancy (NEET PG Preparation Obstetrics & Gynaecology), with the correct answer and a step-by-step solution.
medium · MCQ · Q-4733FE
A 28-year-old primigravida at 34 weeks of gestation presents with a 2-day history of severe right upper quadrant pain, nausea, and vomiting. Laboratory investigations reveal: Hemoglobin 9.2 g/dL, Platelet count , AST 145 IU/L, ALT 160 IU/L, Total Bilirubin 2.8 mg/dL, and LDH 650 IU/L. Peripheral blood smear shows schistocytes. Blood pressure is 142/94 mmHg, and trace proteinuria is present. What is the most appropriate next step in management?
- A.Immediate stabilization and delivery regardless of gestational ageCorrect answer
- B.Conservative management with corticosteroids and magnesium sulfate until 37 weeks
- C.Therapeutic plasma exchange for suspected TTP
- D.Administration of broad-spectrum antibiotics and ursodeoxycholic acid
Solution
This patient presents with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, a severe variant of preeclampsia. At 34 weeks of gestation or beyond, delivery is the definitive treatment to prevent maternal and fetal morbidity. Stabilization with magnesium sulfate for seizure prophylaxis and antihypertensives for severe range blood pressure should be initiated prior to delivery.
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