Severe pre-eclampsia — RACGP Fellowship MCQ

Correct answer: D — Arrange urgent hospital transfer for severe pre-eclampsia assessment and treatment

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as D · D = shown as E

This patient has severe pre-eclampsia requiring urgent hospital transfer. The combination of persistent severe hypertension (≥160/104), symptoms of end-organ dysfunction (headache, visual blurring, epigastric pain), significant proteinuria (2+), and thrombocytopenia (102 × 10⁹/L, <150 indicating risk of HELLP syndrome) all meet criteria for severe pre-eclampsia at 32 weeks' gestation. Australian Therapeutic Guidelines mandate that pre-eclampsia management before 32 weeks occurs in specialist centres with capacity for parenteral antihypertensives (e.g. hydralazine), intravenous magnesium sulphate for eclampsia prevention, and delivery capability. Option A (oral antihypertensive, outpatient review) is dangerous because severe hypertension with neurological symptoms requires acute parenteral therapy in hospital. Option B incorrectly reassures; proteinuria with this clinical picture is not benign. Option D delays necessary emergency assessment by ordering imaging. Option E risks seizure and maternal collapse. C is correct: urgent transfer for comprehensive severe pre-eclampsia management including assessment for imminent eclampsia, HELLP syndrome, and consideration of delivery timing based on fetal and maternal status.

Reference: Australian Prescriber – Hypertensive Disorders of Pregnancy (Therapeutic Guidelines), https://australianprescriber.tg.org.au/articles/hypertensive-disorders-of-pregnancy.html