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Eclampsia — MCCQE Part 1 MCQ

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HardPregnancyEclampsiaMCCQE Part 1

18-year-old woman at 36 weeks' gestation presents with a generalized seizure. BP is 178/116 mmHg and urine protein is positive. Which of the following is the most appropriate next step?

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Correct answer: D — Give magnesium sulphate, control severe BP and plan urgent delivery after stabilisation

Give magnesium sulphate, control severe BP and plan urgent delivery after stabilisation is best because seizure in preeclampsia is eclampsia and magnesium is first-line. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Magnesium prevents recurrent seizures better than benzodiazepines for eclampsia.

Reference: SOGC Guideline No. 426