## Clinical Diagnosis This patient presents with **severe preeclampsia** (BP ≥160/110 mmHg, proteinuria 3+, hyperreflexia with ankle clonus at <37 weeks). **Key Point:** Severe preeclampsia is a medical emergency requiring immediate hospitalization and magnesium sulphate prophylaxis to prevent eclamptic seizures, regardless of whether symptoms are present. ## RCH Protocol for Severe Preeclampsia According to the Reproductive and Child Health (RCH) program and Indian guidelines: 1. **Immediate stabilization** at a tertiary centre 2. **Magnesium sulphate** IV loading dose (4 g IV over 5–10 minutes) followed by maintenance (1 g/hour) — this is the standard seizure prophylaxis 3. **Antihypertensive therapy** (IV labetalol or oral nifedipine) to target MAP reduction of 15–25% in the first hour 4. **Corticosteroids** (betamethasone 12 mg IM × 2 doses, 24 hours apart) for fetal lung maturity at 32 weeks 5. **Delivery** planned after maternal stabilization (usually within 24–48 hours) **High-Yield:** Magnesium sulphate is the drug of choice for seizure prophylaxis in preeclampsia/eclampsia — it is superior to phenytoin and is part of the WHO and Indian standard protocols. **Clinical Pearl:** The presence of ankle clonus (a sign of hyperreflexia) indicates severe disease and imminent risk of eclampsia; this patient requires immediate transfer to a hospital with obstetric and ICU facilities. ## Why Immediate Hospital Admission? - Severe preeclampsia can progress to eclampsia within hours - Magnesium sulphate administration requires IV access and monitoring - Fetal monitoring and delivery planning require tertiary-level facilities - A primary health centre lacks the infrastructure for emergency cesarean or ICU support [cite:Park 26e Ch 10 (RCH), ICMR Guidelines on Hypertension in Pregnancy]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.