Step 2

Obstetrics 3

A 38-year-old woman gravida 3, para 2 at 28 weeks’ gestation presents to the clinic for a prenatal visit. She is concerned about swelling of her hands and feet which began 2 days ago. She denies shortness of breath, dizziness, or loss of consciousness. Past medical history is significant for two prior pregnancies that were uncomplicated. She takes a prenatal vitamin daily. She does not drink alcohol or use drugs but did smoke half a pack of cigarettes daily and stopped when she found out she was pregnant. Family history is significant for a cesarean section delivery in her mother at age 26 years for eclampsia and diagnosis of hypertension at age 47 years. Vital signs are temperature 37.1° C (98.6° F), blood pressure 159/100 mmHg, pulse 95 beats/min, and respirations 18/min. Pelvic examination shows a uterus consistent with 28-week gestation. Fetal heart rate is at 152 beats/min. Labs were done and results are as follows:

  • Hematocrit: 35%
  • Leukocyte count: 10,000/mm3
  • Platelets: 158,000/mm3
  • Creatinine: 1.0 mg/dL
  • Aspartate aminotransferase (AST): 20 U/L
  • Alanine aminotransferase (ALT): 18 U/L
  • Urinalysis
  • Specific Gravity: 1.012
  • RBC: 1/hpf
  • WBC: 0/hpf
  • Protein: 4+

Which of the following is the most appropriate next step in management?

  • A) Admission to the intensive care unit
  • B) Cesarean delivery
  • C) Hydrochlorothiazide
  • D) Induction of labor
  • E) Labetalol


Jessica Ann Jorge


Dr. Ted O'Connell

Last updated

Feb 11, 2024

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