Approach to hypertensive disorders in pregnancy Quiz: Ace Your Exams

A 21-year-old woman, gravida 1, at 34 weeks of gestation, presents to Labor and Delivery triage with a severe, new-onset headache that has been getting progressively worse over the last four hours and swelling in the lower extremities. The patient has no recent travel or exposures, visual changes, shortness of breath, right upper quadrant pain, contractions, loss of fluid, bleeding, or decreased fetal movement. Past medical history is unremarkable, and her only medication is a prenatal vitamin. Temperature is 36.7°C (98.1°F), pulse is 88/min, respirations are 16/min, and blood pressure is 168/110 mmHg. On exam, the patient is alert and oriented, the lungs are clear to auscultation, the abdomen is nontender, and 2+ bilateral pitting edema is present to the mid calves. The cervix is 1 cm dilated, minimally effaced, and at -3 station. The first 10 minutes of maternal-fetal cardiotocographic monitoring show a fetal heart rate in the 130s, moderate variability, two variable decelerations to the 90s, no accelerations, and two contractions. An IV is placed and a repeat set of vital signs demonstrates no significant change. Which of the following is the most appropriate next step in management?