A 30-year-old woman, gravida 1 para 0, at 24 weeks of gestation presents to the emergency department with complaints of persistent headache, blurry vision, and swelling in her hands and feet for the past two days. She denies chest pain, but has some shortness of breath. Her antenatal course has been uneventful until now, with no significant medical history. On examination, the patient has a blood pressure of 170/110 mmHg, a pulse rate of 88 beats per minute, and no fever. Which of the following medications is considered safe and commonly used to treat hypertension in pregnancy?

A 32-year-old woman, gravida 1 para 0, at 34 weeks of gestation presents to the emergency department with complaints of persistent headache, blurry vision, and swelling in her hands and feet for the past two days. She denies chest pain, but has some shortness of breath. Her antenatal course has been uneventful until now, with no significant medical history. On examination, the patient has a blood pressure of 170/110 mmHg, a pulse rate of 88 beats per minute, and no fever. She has pitting edema in both lower extremities. Neurological examination reveals hyperreflexia, but no clonus or seizures. Fundoscopy shows no papilledema. Fetal heart tones are reassuring, and the uterus is non-tender. Laboratory tests Test Result Reference urine protein/creatinine 0.6 normal < 0.3 Platelets 90,000/µL 150,000 - 400,000/µL ALT 78 U/L 10-40 U/L AST 95 U/L 12-38 U/L Serum creatinine 1.5 mg/dL 0.6 - 1.2 mg/dL LDH 450 U/L 45-200 U/L What is the definitive treatment for this patient?

A 30-year-old woman, gravida 1 para 0, at 34 weeks of gestation presents to the emergency department with complaints of persistent headache, blurry vision, and swelling in her hands and feet for the past two days. She denies chest pain, but has some shortness of breath. Her antenatal course has been uneventful until now, with no significant medical history. On examination, the patient has a blood pressure of 170/110 mmHg, a pulse rate of 88 beats per minute, and no fever. She has pitting edema in both lower extremities. Neurological examination reveals hyperreflexia, but no clonus or seizures. Fundoscopy shows no papilledema. Fetal heart tones are reassuring, and the uterus is non-tender. You worried about the possibility of preeclampsia in this patient. Which of the following is NOT a feature of severe preeclampsia?

A 32-year-old woman comes to your obstetrics clinic for preconception counseling. She has a history of hypertension and hypothyroidism for over four years. She takes lisinopril 10 mg daily for hypertension and synthroid 50 mcg for hypothyroidism. Her temperature is 99 °F (37.2 °C), heart rate is 92 beats/min, blood pressure is 142/94 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 97% on room air. She has no medical complaints today. Her physical examination is unremarkable. Regarding the management of her hypertension during pregnancy, which is the most appropriate next step?

A 34-year-old primigravida woman, presented at 34 weeks gestation, reporting ‘not feeling well’. Her medical history was unremarkable except for a recent diagnosis of mild hypertension, which was being monitored. She had no significant family history of pregnancy-related complications. Clinical Presentation: Upon arrival at the emergency department, she appeared distressed and pale. Her vital signs showed a blood pressure of 160/110 mmHg, which was significantly elevated compared to her last check-up. Physical Examination: Among other things, there was no evidence of edema, but her face and hands appeared slightly swollen. Her reflexes were brisk, and she exhibited clonus. Laboratory Findings: Her platelet count was 65,000 per microliter, Liver function tests showed an AST of 200 U/L and an ALT of 180 U/L. LDH was elevated at 650 U/L, and blood smear revealed schistocytes. What clinical symptom is most commonly associated with this disorder?

A 32-year-old woman, gravida 2 para 1, at 35 weeks of gestation, presents to the emergency department with complaints of severe epigastric and right upper quadrant (RUQ) pain for the past 8 hours. She also reports nausea, fatigue, and a headache that has not improved with acetaminophen. She denies seizures, visual disturbances, or vaginal bleeding. Her prenatal care had been uneventful until this visit. Examination Findings: Vital Signs: BP 170/110 mmHg, HR 96 bpm, Temp 98.9°F. General Exam: The patient appears uncomfortable and fatigued. Abdominal Exam: RUQ tenderness without rebound or guarding. Neurological Exam: No focal deficits or signs of clonus. Investigations: 1.Laboratory Results: Test Result Reference Alanine aminotransferase (ALT) 140 10 – 40 U/L Aspartate aminotransferase (AST) 120 12 – 38 U/L Platelet count 85,000 150,000 – 400,000/mm³ Lactate dehydrogenase 680 45 – 200 U/L Peripheral smear: Schistocytes Urine 3+ proteins 2.Imaging: Liver Ultrasound: Normal, with no evidence of hematoma or rupture. Fetal Monitoring: Non-stress test shows a reassuring fetal heart rate pattern.What is the definitive treatment for this disorder?

A 32-year-old woman, gravida 2 para 1, at 35 weeks of gestation, presents to the emergency department with complaints of severe epigastric and right upper quadrant (RUQ) pain for the past 8 hours. She also reports nausea, fatigue, and a headache that has not improved with acetaminophen. She denies seizures, visual disturbances, or vaginal bleeding. Her prenatal care had been uneventful until this visit. Examination Findings: Vital Signs: BP 170/110 mmHg, HR 96 bpm, Temp 98.9°F. General Exam: The patient appears uncomfortable and fatigued. Abdominal Exam: RUQ tenderness without rebound or guarding. Neurological Exam: No focal deficits or signs of clonus. Which of the following laboratory findings is most consistent with HELLP syndrome in this patient?

A 30-year-old woman at 34 weeks of gestation presents to the emergency department with severe preeclampsia. Her blood pressure is 168/110 mmHg, and she has significant proteinuria (4+ on dipstick) and mild headaches. She is admitted to the obstetric ward and started on magnesium sulfate for seizure prophylaxis and antihypertensive therapy. The magnesium sulfate infusion is initiated with a loading dose of 4 g intravenously over 30 minutes, followed by a maintenance dose of 2 g/hour. Her reflexes and vital signs are monitored hourly, and she initially responds well to the therapy. After 8 hours of infusion, the patient begins to report nausea and generalized weakness. The nurse notes that her respiratory rate has decreased to 10 breaths per minute, and her deep tendon reflexes are absent on examination. The patient also complains of flushing and mild dizziness. Concerned about possible magnesium toxicity, the medical team orders immediate serum magnesium levels. At what serum magnesium level do this patient’s current symptoms and signs typically occur?

A 29-year-old woman at 34 weeks of gestation presents to the emergency department with severe preeclampsia. Her blood pressure is 168/110 mmHg, and she has significant proteinuria (4+ on dipstick) and mild headaches. She is admitted to the obstetric ward and started on magnesium sulfate for seizure prophylaxis and antihypertensive therapy. The magnesium sulfate infusion is initiated with a loading dose of 4 g intravenously over 30 minutes, followed by a maintenance dose of 2 g/hour. After 8 hours of infusion, the patient begins to report nausea and generalized weakness. The nurse notes that her respiratory rate has decreased to 10 breaths per minute, and her deep tendon reflexes are absent on examination. The patient also complains of flushing and mild dizziness. What is the appropriate management step in the management of this patient?

A 32-year-old woman at 34 weeks of gestation presents to the emergency department with severe preeclampsia. Her blood pressure is 168/110 mmHg, and she has significant proteinuria (4+ on dipstick) and mild headaches. She is admitted to the obstetric ward and started on magnesium sulfate, with a loading dose of 4 g intravenously over 30 minutes, followed by a maintenance dose of 2 g/hour. After 8 hours of infusion, the patient begins to report nausea and generalized weakness. You suspect magnesium toxicity. What is the earliest clinical sign of magnesium toxicity in patients receiving magnesium sulfate for preeclampsia?