## Clinical Context This is a case of suspected severe preeclampsia (hypertension ≥160/110 mmHg, proteinuria, and neurological symptoms) at 32 weeks gestation in a rural setting with limited infrastructure. ## Role of Sub-Centre in Maternal Care **Key Point:** The Sub-Centre is the most basic unit of the public health system with limited diagnostic and therapeutic capacity. It serves a population of 3,000–5,000 (in plains) and is staffed by ANM(F) and ANM(M) only. **High-Yield:** Sub-Centres are **NOT equipped** for: - Advanced investigations (ultrasound, laboratory tests) - Parenteral antihypertensive therapy - Magnesium sulphate administration (requires trained personnel and monitoring) - Management of obstetric emergencies ## Appropriate Referral Pathway **Clinical Pearl:** Severe preeclampsia is a **obstetric emergency** requiring: 1. Immediate referral to CHC or higher facility 2. Assessment by trained obstetrician 3. Fetal monitoring (NST, ultrasound) 4. Parenteral antihypertensive therapy if indicated 5. Magnesium sulphate prophylaxis (if seizure risk) 6. Plan for delivery based on maternal and fetal condition **Mnemonic: REFER** — **R**ecognize danger signs, **E**valuate severity, **F**acilitate referral, **E**nsure transport, **R**eceive at higher centre. ## Why Urgent Referral to CHC? The CHC is the first referral centre with: - Obstetric expertise - Laboratory and ultrasound facilities - Parenteral medications and monitoring capability - 24-hour availability - Capacity to manage complications and arrange delivery **Key Point:** Delaying referral in severe preeclampsia increases risk of eclampsia, placental abruption, HELLP syndrome, and maternal/fetal mortality.
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