A 28-year-old primigravida at 36 weeks gestation presents with severe headache, visual disturbances, and epigastric pain. Her blood pressure is 165/110 mmHg, and urinalysis shows 3+ proteinuria. What is the next best step in management? A) IV magnesium sulfate B) Labetalol IV C) Induction of labour D) Hydralazine IV E) Nifedipine oral Correct Answer: B) Labetalol IV Explanation: Severe pre-eclampsia (BP ≥160/110 + proteinuria + symptoms) → Immediate BP control. First-line antihypertensive: IV labetalol Alternative: IV hydralazine or oral nifedipine Prevent eclampsia (seizures) → IV magnesium sulfate (if seizures occur) Delivery is the only definitive treatment but needs stabilisation first. A) IV magnesium sulfate → Incorrect. Used for eclampsia (seizures), not initial BP control. C) Induction of labour → Incorrect. First, stabilise BP before considering delivery. D) Hydralazine IV → Incorrect. Second-line after labetalol. E) Nifedipine oral → Incorrect. Can be used, but IV labetalol preferred for severe cases. Key Tips for PLAB 1: ✅ Severe pre-eclampsia = BP ≥160/110 + proteinuria + symptoms ✅ First-line: IV labetalol (or hydralazine/nifedipine if contraindicated) ✅ Magnesium sulfate for seizure prevention (if eclampsia develops)
