Pregnancy Medicine — MCQs

Q: A 28-year-old woman at 34 weeks gestation presents with sudden onset severe headache and seizures. Her BP is 180/120 mmHg. What is the most appropriate immediate treatment?

Magnesium sulfate IV. ***Magnesium sulfate IV***- **Magnesium sulfate** is the first-line and definitive treatment for the prevention and cessation of seizures in women with **eclampsia**.- It acts by stabilizing neuronal membranes and reducing neuromuscular irritability, providing effective seizure control superior to traditional *anticonvulsants*.*Labetalol IV*- Labetalol is an **antihypertensive** used to manage severe *hypertension* (BP 160/110 mmHg) in preeclampsia/eclampsia, but it does not treat or prevent the underlying seizures.- Control of blood pressure is secondary to achieving **seizure cessation** and prevention with magnesium sulfate in the immediate management protocol.*Immediate cesarean section*- Delivery is the definitive cure for eclampsia and severe preeclampsia, but immediate **maternal stabilization**, including seizure control (MgSO4) and blood pressure management, must precede delivery unless other emergent obstetric indications exist.- A planned delivery is necessary once the patient is stable, but the *seizures* must be controlled first, making MgSO4 the most **immediate** necessary step.*Diazepam IV*- While an effective general anticonvulsant, **diazepam** is generally reserved as a *second-line agent* if seizures persist despite adequate administration of magnesium sulfate.- Magnesium sulfate is preferred because it is more effective for eclamptic seizures and carries a lower risk of fetal respiratory depression and **neonatal hypotonia** compared to benzodiazepines.*Mannitol IV*- **Mannitol** is an osmotic diuretic primarily used to reduce increased *intracranial pressure* (ICP) or treat cerebral edema.- It is not the primary immediate agent for *seizure control* in eclampsia, which requires **magnesium sulfate**.