A 28-year-old G2P1 woman at 36 weeks gestation, diagnosed with preeclampsia with severe features, is admitted to the labor and delivery unit and started on intravenous magnesium sulfate for seizure prophylaxis. Her initial blood pressure was 170/110 mmHg, and she reported persistent frontal headaches and epigastric pain. Four hours into the infusion, a nurse notes the patient is becoming increasingly lethargic and complains of blurred vision. Her respiratory rate is now 10 breaths per minute, down from 16, and her deep tendon reflexes are diminished (1+ bilaterally). Her urine output has also significantly decreased over the last hour. What is the most likely diagnosis, and what is the most appropriate immediate intervention?

A 33-year-old woman at 37 weeks gestation presents to the emergency department with a 24-hour history of severe headache, generalized malaise, and epigastric pain. Her past medical history is unremarkable, and she is taking prenatal vitamins. Vital signs upon admission include a temperature of 37.2°C, blood pressure of 177/108 mmHg, pulse of 100 beats/min, respiratory rate of 16 breaths/min, and oxygen saturation of 97% on room air. Physical examination reveals diffuse abdominal tenderness, particularly in the right upper quadrant, and 2+ pitting edema in the lower extremities. Deep tendon reflexes are noted to be 3+ bilaterally with clonus. A spot urine protein to creatinine ratio is 37. A peripheral smear also reveals schistocytes. Given these findings, what is the most appropriate initial management strategy, and what critical complication must be actively monitored for?

A 30-year-old primigravida, G1P0, at 33 weeks and 5 days gestation, was initially admitted to the high-risk obstetrics unit for escalating upper abdominal discomfort, particularly in the right upper quadrant, accompanied by persistent nausea. Over the past 48 hours, she has also reported a severe, unremitting frontal headache and blurred vision. On admission, her vital signs were: temperature 37.0°C, blood pressure 168/92 mmHg, pulse 92/min, respirations 20/min, and oxygen saturation 97% on room air. Physical examination revealed generalized edema and hyperreflexia. Urine dipstick shows significant proteinuria and microscopic hematuria. Despite initial management with antihypertensives, the patient suddenly develops a generalized tonic-clonic seizure. Given her presentation, what is the most likely diagnosis and the immediate definitive management strategy to prevent further complications?

Ms. Eleanor Vance, a 30-year-old G1P0, presents to the emergency department at 30 weeks gestation reporting a persistent frontal headache, subjective visual disturbances including 'spots,' and mild epigastric pain for the past 24 hours. Her prenatal care has been routine until now. On examination, her temperature is 37.0 C, blood pressure is 168/108 mmHg, pulse is 96 beats/min, respirations are 20 breaths/min, and oxygen saturation is 99% on room air. Physical examination reveals a gravid uterus consistent with gestation, and mild peripheral edema is noted. Deep tendon reflexes are 2+. Auscultation of heart and lungs is unremarkable. What is the most appropriate diagnosis given her presentation and lab findings, and what is the immediate next step in her management?

A 24-year-old woman, G1P0, at 36 weeks gestation, was admitted to the labor and delivery unit two days ago with severe preeclampsia, characterized by blood pressures consistently above 160/110 mmHg, persistent headache, right upper quadrant pain, and proteinuria. Despite initial management with intravenous labetalol and close monitoring, she experiences a generalized tonic-clonic seizure lasting approximately 90 seconds while in her hospital bed. Upon assessment immediately post-ictally, her blood pressure is 175/115 mmHg, pulse is 98/min, respirations are 18/min, and oxygen saturation is 96% on room air. She is disoriented but responsive to voice. Deep tendon reflexes are noted to be 3+ bilaterally with clonus. What is the most likely diagnosis and the immediate definitive management for this patient?

A 30-year-old primigravida presents to the emergency department three days after an uncomplicated spontaneous vaginal delivery at 39 weeks gestation. She complains of a persistent, severe frontal headache, intermittent blurred vision, and epigastric pain that began a few hours ago. She also reports feeling generally unwell and slightly confused at times. Her blood pressure upon arrival is 198/112 mmHg, pulse 95/min, respirations 16/min, and oxygen saturation 99% on room air. Her temperature is 37.0°C. Physical examination reveals mild facial and pedal edema. Fundal height is appropriate for the postpartum period, and there is moderate lochia with a well-contracted uterus. Neurological exam shows no focal deficits, but she appears disoriented to time and place. Deep tendon reflexes are 3+ bilaterally with clonus present at the ankles. What is the most likely diagnosis, and what is the immediate, life-saving therapeutic intervention indicated?

A 30-year-old primigravida at 34 weeks gestation presents to the emergency department reporting a severe, persistent headache, blurry vision, and generalized swelling that started acutely. She also reports that her blood pressure readings at home have been consistently elevated in the past few days. Her medical history is significant for gestational diabetes. On examination, she appears distressed with significant periorbital and lower extremity edema. Her blood pressure is 160/105 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 96% on room air. Her reflexes are brisk, and no clonus is noted. What is the most likely diagnosis and the immediate therapeutic intervention indicated?