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Postpartum gestational diabetes follow-up — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Postpartum gestational diabetes follow-upUSMLE Step 3

Five days after delivery, a patient has persistent blood pressure of 168/112 mm Hg, severe headache, visual scintillations, hyperreflexia, pulse 52/min, and severe asthma. Oxygenation is normal and there is no pulmonary edema. What is the best immediate treatment plan?

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Correct answer: B — Give immediate-release oral nifedipine promptly and administer magnesium sulfate for seizure prophylaxis

The best answer is “Give immediate-release oral nifedipine promptly and administer magnesium sulfate for seizure prophylaxis”. Persistent postpartum pressure at or above 160/110 is an emergency requiring rapid treatment. Immediate-release nifedipine is a first-line option and avoids the bradycardia and bronchospasm concerns that make labetalol poorly matched here. Severe neurologic features support magnesium sulfate for eclampsia prophylaxis. Longer-acting outpatient therapy and diuresis may have later roles but cannot replace immediate pressure and seizure-risk control.

Reference: ACOG Severe Hypertension in Pregnancy Bundle: https://www.acog.org/community/districts-and-sections/district-ii/programs-and-resources/safe-motherhood-initiative/severe-hypertension