Typical exam stem
A woman at 35 weeks' gestation presents with severe hypertension, headache and visual disturbance. How would you assess and manage her?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What severe features make pre-eclampsia high risk?
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Recognise severe disease quickly
Pre-eclampsia is a hypertensive disorder arising after 20 weeks of pregnancy with maternal organ dysfunction, uteroplacental dysfunction or proteinuria depending on the diagnostic framework used. Severe headache, visual symptoms, right upper quadrant or epigastric pain, severe hypertension, thrombocytopenia, renal impairment, pulmonary oedema or neurological symptoms indicate higher risk.
Assessment
- Repeat and confirm blood pressure using correct technique.
- Assess neurological, respiratory and cardiovascular status and look for oedema or pulmonary oedema.
- Check urine protein, full blood count including platelets, renal function and liver enzymes.
- Assess fetal wellbeing and gestational age because maternal and fetal status influence timing of delivery.
Management principles
Treat severe hypertension promptly using an appropriate pregnancy-safe agent. Magnesium sulfate is used to prevent or treat eclamptic seizures in patients with severe disease according to current obstetric protocol. The definitive treatment is delivery, but timing depends on gestation, severity, maternal stability and fetal status.
An eclamptic seizure requires airway and safety support, magnesium sulfate, blood-pressure control and urgent obstetric assessment. Do not attribute a seizure in pregnancy to epilepsy until eclampsia and other serious causes have been considered.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.