Gestational hypertension, preeclampsia, eclampsia, and HELLP Quiz: Ace Your Exams

A 20-year-old woman, gravida 1, at 32 weeks of gestation presents to Labor and Delivery triage with a severe headache for the last six hours that has not responded to acetaminophen at home. The headache is severe, bilateral, throbbing, and rated 8 on a 10-point scale. She has mild photophobia but no scotomata, blurred vision, or other visual disturbances. She also has no chest pain, shortness of breath, nausea, abdominal pain, contractions, loss of fluid, bleeding, or decreased fetal movement. Past medical history is noncontributory, and her only medication is a prenatal vitamin. Temperature is 36.5°C (97.8°F), pulse is 90/min, respirations are 18/min, and blood pressure is 150/105 mmHg. On exam, there are no focal neurologic deficits, the lungs are clear to auscultation bilaterally, the abdomen is non-tender, and there is 2+ bilateral pitting edema of the lower extremities to the mid-calves. The patient is monitored in triage and labs are drawn. Serial blood pressures remain elevated (systolic range 146-158, diastolic range 90-108), and her headache improves. In addition to initiating magnesium sulfate and giving antihypertensive agents as needed, which of the following is the most appropriate management plan for this patient?

Laboratory value	Result
Serum chemistry
Hemoglobin	10.8 g/dL
Leukocyte count	6,300 /mm3
Platelet count	135,000/mm3
Sodium	141 mEq/L
Potassium	4.0 mEq/L
Chloride	95 mEq/L
Creatinine (Cr)	1.2 mg/dL
Alanine aminotransferase (ALT)	20 IU/L
Aspartate aminotransferase (AST)	24 IU/L
Lactate dehydrogenase (LDH)	340 IU/L
Urinalysis
Color
Specific gravity	Clear
Glucose	negative
Blood	negative
Protein	2+
Leukocyte esterase	negative
Nitrites	negative
Protein to creatinine ratio	0.3