Pregnancy Medicine — MCQs
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A 27-year-old woman attends for antenatal booking at 8 weeks gestation. She has a BMI of 34 kg/m². Her past medical history includes polycystic ovary syndrome. Her mother was diagnosed with type 2 diabetes aged 48 years. She had a previous baby weighing 4.2 kg at term. What is the most appropriate timing for her first oral glucose tolerance test (OGTT)?
A 30-year-old woman books for antenatal care at 9 weeks gestation. She was born in Vietnam and immigrated to the UK 5 years ago. She has had no previous pregnancies. She is unsure of her vaccination history. According to current UK antenatal screening guidelines, which infection screening should be offered at the booking appointment?
A 32-year-old woman at 30 weeks gestation presents with BP 144/94 mmHg. She is asymptomatic. Urine PCR is 18 mg/mmol. Blood tests show: platelets 210 × 10⁹/L, ALT 32 U/L, creatinine 62 µmol/L. She is commenced on labetalol. At 34 weeks, her BP remains 142/92 mmHg on labetalol 200 mg TDS, but all other parameters remain normal. What is the optimal timing for delivery?
A 39-year-old woman with pre-existing type 2 diabetes is reviewed at 8 weeks gestation. Her medications include metformin 1g BD and gliclazide 80 mg BD. HbA1c is 58 mmol/mol. She is taking folic acid 5 mg daily. What is the most important medication change required?
A 26-year-old primigravida at 36 weeks gestation with gestational diabetes controlled on insulin presents with reduced fetal movements for 8 hours. CTG shows baseline rate 145 bpm with normal variability, no accelerations, and no decelerations. What is the most appropriate management?
A 35-year-old woman at 18 weeks gestation is found to have BP 158/102 mmHg at routine antenatal appointment. Review of her notes shows BP was 154/98 mmHg at booking at 8 weeks. She has no symptoms. Urine dipstick is negative for protein. Blood tests are normal. What is the most accurate diagnosis?
A 40-year-old woman is diagnosed with gestational diabetes at 26 weeks following an oral glucose tolerance test with fasting glucose of 5.8 mmol/L and 2-hour glucose of 9.1 mmol/L. She has been referred to the diabetes in pregnancy clinic. Which additional antenatal intervention is specifically recommended due to her gestational diabetes diagnosis?
A 31-year-old woman attends her dating scan which confirms she is at 13 weeks gestation. Combined screening shows: nuchal translucency 2.1 mm, PAPP-A 0.4 MoM, beta-hCG 1.8 MoM, giving a risk of 1:85 for trisomy 21. She declines invasive testing but asks about additional screening. What should be offered?
A 37-year-old woman with gestational diabetes at 34 weeks gestation has growth scans showing estimated fetal weight on 95th centile with abdominal circumference on 97th centile. She has been managing with diet alone. Fasting glucose is 5.8 mmol/L and 2-hour postprandial glucose is 8.2 mmol/L. What is the most appropriate management?
A 33-year-old woman at 24 weeks gestation is found to have a blood pressure of 152/98 mmHg at routine antenatal clinic. She is asymptomatic. Booking BP at 12 weeks was 118/76 mmHg. Urine dipstick shows trace protein. Blood tests show: creatinine 68 µmol/L, ALT 28 U/L, platelets 245 × 10⁹/L. What is the most appropriate next investigation?
Pregnancy Medicine UK Medical PG Practice Questions and MCQs
Question 161: A 27-year-old woman attends for antenatal booking at 8 weeks gestation. She has a BMI of 34 kg/m². Her past medical history includes polycystic ovary syndrome. Her mother was diagnosed with type 2 diabetes aged 48 years. She had a previous baby weighing 4.2 kg at term. What is the most appropriate timing for her first oral glucose tolerance test (OGTT)?
- A. Now at booking (Correct Answer)
- B. At 16 weeks gestation
- C. At 20 weeks gestation
- D. At 24-28 weeks gestation
- E. Only if symptomatic
Explanation: ***Now at booking***- This patient presents with multiple significant risk factors for **gestational diabetes (GDM)** or undiagnosed pre-existing diabetes, including a **BMI of 34 kg/m² (obesity)**, **polycystic ovary syndrome (PCOS)**, a **first-degree relative with type 2 diabetes**, and a history of a **macrosomic baby (4.2 kg)**.- **NICE guidelines** and other major recommendations advise offering an **oral glucose tolerance test (OGTT)** as early as possible after booking (ideally at 8-12 weeks) for women with such a high-risk profile, to allow for prompt diagnosis and management.*At 16 weeks gestation*- While some guidelines might consider screening at 16-18 weeks for certain elevated risks, for a patient with this many and severe risk factors, waiting until 16 weeks would unduly delay critical early diagnosis and intervention.- The aim is to identify **hyperglycemia** as soon as possible in pregnancy to mitigate associated risks, making an earlier test at booking more appropriate.*At 20 weeks gestation*- This timing does not align with established **GDM screening protocols**, which typically recommend either early screening at booking or later in the second trimester (24-28 weeks).- Delaying the initial test to 20 weeks in a high-risk individual could lead to prolonged exposure of the fetus to **hyperglycemia**, potentially increasing the risks of complications such as **fetal macrosomia** and pre-eclampsia.*At 24-28 weeks gestation*- This is the standard timing for **routine OGTT screening** for women who have at least one risk factor (e.g., BMI >30 or family history), but who do not have the cumulative high-risk profile requiring earlier intervention.- For this patient, while a repeat OGTT might be performed at 24-28 weeks if the initial booking test is negative, the **first OGTT** should be conducted much earlier due to her substantial risk factors.*Only if symptomatic*- **Gestational diabetes** is frequently **asymptomatic**, meaning many women with the condition do not experience noticeable symptoms.- Relying solely on symptoms for diagnosis is an ineffective and dangerous approach that would lead to missed cases, delaying necessary management and increasing the risk of **maternal and fetal complications**, including **macrosomia**.
Question 162: A 30-year-old woman books for antenatal care at 9 weeks gestation. She was born in Vietnam and immigrated to the UK 5 years ago. She has had no previous pregnancies. She is unsure of her vaccination history. According to current UK antenatal screening guidelines, which infection screening should be offered at the booking appointment?
- A. HIV, hepatitis B, hepatitis C, and syphilis
- B. HIV, hepatitis B, rubella immunity, and syphilis (Correct Answer)
- C. HIV, hepatitis B, syphilis, and toxoplasmosis
- D. HIV, hepatitis B, syphilis, and cytomegalovirus
- E. HIV, hepatitis B, rubella immunity, syphilis, and varicella immunity
Explanation: ***HIV, hepatitis B, rubella immunity, and syphilis*** - According to **UK National Screening Committee (NSC)** and **NICE** guidelines, these four conditions comprise the standard infectious disease screening offered at the **booking appointment**. - Screening facilitates interventions to prevent **mother-to-child transmission** for HIV, Hep B, and syphilis, and identifies the need for **postnatal MMR vaccination** for rubella susceptibility. *HIV, hepatitis B, hepatitis C, and syphilis* - **Hepatitis C** is not currently part of the routine universal antenatal screening programme in the UK. - It is typically only offered to women identified as having **high-risk factors**, rather than being a standard booking test for all. *HIV, hepatitis B, syphilis, and toxoplasmosis* - **Toxoplasmosis** screening is not recommended in the UK as there is a lack of evidence that routine screening/treatment improves outcomes. - Prevention focuses on **hygiene advice** regarding cat litter and undercooked meat rather than blood tests at booking. *HIV, hepatitis B, syphilis, and cytomegalovirus* - **Cytomegalovirus (CMV)** screening is not part of the standard UK antenatal panel because there is no established vaccine or proven treatment to prevent fetal infection. - Professional bodies emphasize **hand hygiene** and avoiding sharing food/utensils with young children to reduce risk instead. *HIV, hepatitis B, rubella immunity, syphilis, and varicella immunity* - Routine screening for **varicella (chickenpox) immunity** is not standard practice for every pregnant woman at the booking visit. - Testing for varicella antibodies is usually reserved for women with no clear history of infection who have a **significant exposure** during pregnancy.
Question 163: A 32-year-old woman at 30 weeks gestation presents with BP 144/94 mmHg. She is asymptomatic. Urine PCR is 18 mg/mmol. Blood tests show: platelets 210 × 10⁹/L, ALT 32 U/L, creatinine 62 µmol/L. She is commenced on labetalol. At 34 weeks, her BP remains 142/92 mmHg on labetalol 200 mg TDS, but all other parameters remain normal. What is the optimal timing for delivery?
- A. Immediate delivery at 34 weeks
- B. 37 weeks gestation (Correct Answer)
- C. 38 weeks gestation
- D. 39 weeks gestation
- E. Await spontaneous labour up to 40 weeks
Explanation: ***37 weeks gestation***- This patient has **gestational hypertension** as evidenced by blood pressure ≥ 140/90 mmHg after 20 weeks gestation, without significant **proteinuria** (PCR 18 mg/mmol is below the 30 mg/mmol threshold for pre-eclampsia) or end-organ dysfunction.- Current guidelines, such as NICE, recommend planned delivery at **37+0 weeks** for gestational hypertension to reduce the risk of maternal complications without increasing neonatal morbidity.*Immediate delivery at 34 weeks*- This aggressive approach is typically indicated for **severe pre-eclampsia**, HELLP syndrome, or fetal distress, none of which are present in this stable, asymptomatic patient.- Delivering at 34 weeks would result in unnecessary **iatrogenic prematurity** and its associated neonatal health risks.*38 weeks gestation*- Delaying delivery until 38 weeks in a patient with gestational hypertension who is on medication increases the risk of developing **pre-eclampsia** or other severe hypertensive complications.- The evidence-based optimal timing for delivery in stable gestational hypertension to balance maternal and neonatal outcomes is specifically at **37 weeks**.*39 weeks gestation*- Expectant management until 39 weeks is generally reserved for women with very mild gestational hypertension, often without the need for pharmacological intervention.- As this woman requires **labetalol** to manage her blood pressure, delaying delivery beyond 37 weeks increases the risk of worsening maternal condition without significant fetal benefit.*Await spontaneous labour up to 40 weeks*- Allowing a pregnancy complicated by gestational hypertension, especially when medicated, to proceed to **40 weeks** or beyond significantly increases the risk of serious adverse outcomes.- These risks include an elevated chance of **placental abruption**, severe pre-eclampsia, and stillbirth, making planned delivery the safer option.
Question 164: A 39-year-old woman with pre-existing type 2 diabetes is reviewed at 8 weeks gestation. Her medications include metformin 1g BD and gliclazide 80 mg BD. HbA1c is 58 mmol/mol. She is taking folic acid 5 mg daily. What is the most important medication change required?
- A. Stop metformin and commence insulin
- B. Stop gliclazide and commence insulin (Correct Answer)
- C. Continue current medications and recheck HbA1c in 4 weeks
- D. Stop both oral agents and commence insulin
- E. Increase gliclazide dose to improve control
Explanation: ***Stop gliclazide and commence insulin*** - **Gliclazide** (a sulfonylurea) is contraindicated in pregnancy due to the risk of **neonatal hypoglycemia** and potential **teratogenicity**, making its discontinuation essential. - **Insulin** is the first-line pharmacotherapy for diabetes in pregnancy when glycemic targets (HbA1c <48 mmol/mol) are not met, as it effectively controls blood glucose and **does not cross the placenta**, ensuring fetal safety. *Stop metformin and commence insulin* - **Metformin** is generally considered safe and can be continued in pregnancy for women with type 2 diabetes, helping to manage **glycemic control** and potentially reducing insulin requirements. - Unnecessarily stopping metformin would remove a beneficial agent and could lead to higher **insulin doses** or poorer control. *Continue current medications and recheck HbA1c in 4 weeks* - An **HbA1c of 58 mmol/mol** (approximately 7.5%) is well above the recommended target for pregnancy (typically <48 mmol/mol or 6.5%) and requires immediate intervention to reduce risks of **fetal malformations** and **macrosomia**. - Continuing **gliclazide** in pregnancy is unsafe due to the risk of **neonatal hypoglycemia** and should be stopped immediately, not continued. *Stop both oral agents and commence insulin* - While stopping gliclazide is correct, **metformin** can generally be continued in pregnancy, as it is considered safe and may provide benefits in glycemic control and **weight management**. - The optimal approach often involves continuing metformin while initiating or intensifying **insulin therapy** to achieve tight glycemic control. *Increase gliclazide dose to improve control* - Increasing the dose of **gliclazide** (a sulfonylurea) is contraindicated in pregnancy due to significant risks of **fetal hyperinsulinemia** and **neonatal hypoglycemia**. - For inadequate glycemic control during pregnancy, the appropriate action is to initiate or increase **insulin therapy**, not to adjust potentially harmful oral agents.
Question 165: A 26-year-old primigravida at 36 weeks gestation with gestational diabetes controlled on insulin presents with reduced fetal movements for 8 hours. CTG shows baseline rate 145 bpm with normal variability, no accelerations, and no decelerations. What is the most appropriate management?
- A. Reassure and discharge home with advice to monitor movements
- B. Repeat CTG in 4 hours
- C. Perform vibroacoustic stimulation and continue CTG (Correct Answer)
- D. Arrange immediate delivery by caesarean section
- E. Admit for twice-daily CTG monitoring
Explanation: ***Perform vibroacoustic stimulation and continue CTG*** - The absence of accelerations on CTG indicates a **non-reactive trace**, which may be caused by a **fetal sleep cycle** (usually lasting 20-40 minutes) or fetal compromise, especially in a high-risk pregnancy with **gestational diabetes**. - **Vibroacoustic stimulation (VAS)** is the next step to provoke fetal movement and accelerations, aiming to confirm fetal well-being before more invasive interventions are considered. *Reassure and discharge home with advice to monitor movements* - Discharging the patient is inappropriate because a **non-reactive CTG** in the context of **reduced fetal movements** and high-risk **gestational diabetes (GDM) on insulin** requires further evaluation. - Guidelines mandate that fetal well-being must be confirmed via a **reactive trace** or ultrasound before the patient can safely be sent home. *Repeat CTG in 4 hours* - Delaying the assessment for 4 hours is unsafe in a high-risk pregnancy with potentially compromised fetal status; the **fetal sleep cycle** should be addressed immediately. - Management should be active, using **fetal acoustic stimulation** or prolonged monitoring to ensure the trace becomes reactive within 40-60 minutes. *Arrange immediate delivery by caesarean section* - Immediate delivery is not indicated when the CTG shows **normal baseline variability** and no decelerations, as these findings suggest the fetus is not in acute distress. - **Caesarean section** carries significant maternal-fetal risks and should only be performed if there is definitive evidence of **fetal distress** or after failed conservative measures. *Admit for twice-daily CTG monitoring* - Admission for twice-daily monitoring is not indicated until a definitive diagnosis or assessment of the **current episode** of reduced fetal movements is completed. - The immediate priority is to convert the **non-reactive CTG** into a reactive one or proceed to a **biophysical profile** or Doppler studies to determine if delivery is necessary.
Question 166: A 35-year-old woman at 18 weeks gestation is found to have BP 158/102 mmHg at routine antenatal appointment. Review of her notes shows BP was 154/98 mmHg at booking at 8 weeks. She has no symptoms. Urine dipstick is negative for protein. Blood tests are normal. What is the most accurate diagnosis?
- A. Chronic hypertension (Correct Answer)
- B. Gestational hypertension
- C. Pre-eclampsia
- D. White coat hypertension
- E. Pregnancy-induced hypertension
Explanation: ***Chronic hypertension*** - Defined as hypertension present **before 20 weeks gestation** or pre-dating the pregnancy; this patient had elevated BP at her **8-week booking** appointment. - Since the blood pressure remains elevated at 18 weeks without **proteinuria**, it confirms a baseline hypertensive state rather than a pregnancy-specific onset. *Gestational hypertension* - This diagnosis refers to new-onset hypertension occurring **after 20 weeks gestation** in a previously normotensive woman. - It is excluded here because the patient's records specifically document high blood pressure at the **8-week mark**. *Pre-eclampsia* - Characterized by new hypertension after 20 weeks combined with significant **proteinuria** or maternal **organ dysfunction**. - The absence of protein on a **urine dipstick** and normal blood tests at 18 weeks rule out this condition for the current presentation. *White coat hypertension* - Refers to elevated BP readings only in clinical settings, with normal readings at home or via **ambulatory monitoring**. - While possible, the consistent elevation at **different time points** (8 and 18 weeks) strongly points toward established **chronic hypertension** as the accurate diagnosis. *Pregnancy-induced hypertension* - This is an umbrella term often used interchangeably with **gestational hypertension**, occurring late in the second or third trimester. - It does not apply to hypertension that is present at **booking** or during the first trimester of pregnancy.
Question 167: A 40-year-old woman is diagnosed with gestational diabetes at 26 weeks following an oral glucose tolerance test with fasting glucose of 5.8 mmol/L and 2-hour glucose of 9.1 mmol/L. She has been referred to the diabetes in pregnancy clinic. Which additional antenatal intervention is specifically recommended due to her gestational diabetes diagnosis?
- A. Growth scans every 2 weeks from diagnosis
- B. Growth scans at 28, 32, and 36 weeks gestation
- C. Additional ultrasound scan at 28 weeks and then every 4 weeks (Correct Answer)
- D. Weekly biophysical profile from 32 weeks
- E. Twice-weekly cardiotocography from 28 weeks
Explanation: ***Additional ultrasound scan at 28 weeks and then every 4 weeks***- For women with **gestational diabetes (GDM)**, ultrasound monitoring for **fetal growth** and **amniotic fluid volume** is specifically recommended at **28, 32, and 36 weeks**.- This intervention aims to detect **macrosomia** and **polyhydramnios**, which are indicators of fetal hyperinsulinemia and suboptimal **glycemic control**.*Growth scans every 2 weeks from diagnosis*- Monitoring every 2 weeks is not routine practice for GDM as it is **excessive** and does not provide additional evidence-based clinical benefit over standard 4-week intervals.- Frequent scans are generally reserved for high-risk cases of **fetal growth restriction (FGR)** or specific maternal complications.*Growth scans at 28, 32, and 36 weeks gestation*- While the schedule of 28, 32, and 36 weeks is correct, the standard description of this protocol in clinical guidelines is often framed as an **additional scan at 28 weeks** followed by **4-weekly monitoring**.- This distinguishes the specific GDM monitoring pathway from regular antenatal care which lacks serial late-trimester growth assessments.*Weekly biophysical profile from 32 weeks*- **Biophysical profiles** are not routinely indicated for GDM unless there are specific concerns regarding **fetal wellbeing** or significant maternal complications.- Routine growth scans are preferred as they specifically monitor for the complications most typical of diabetes, such as **asymmetric macrosomia**.*Twice-weekly cardiotocography from 28 weeks*- Routine **cardiotocography (CTG)** is not recommended for GDM unless there are clinical indications like reduced fetal movements or poor glucose control.- Starting **twice-weekly CTG** from 28 weeks is not supported by guidelines, as fetal monitoring usually intensifies closer to the **delivery date** if treatment (insulin) is required.
Question 168: A 31-year-old woman attends her dating scan which confirms she is at 13 weeks gestation. Combined screening shows: nuchal translucency 2.1 mm, PAPP-A 0.4 MoM, beta-hCG 1.8 MoM, giving a risk of 1:85 for trisomy 21. She declines invasive testing but asks about additional screening. What should be offered?
- A. Non-invasive prenatal testing (NIPT) (Correct Answer)
- B. Repeat combined screening at 16 weeks
- C. Quadruple test at 16 weeks
- D. Detailed anomaly scan at 20 weeks only
- E. Amniocentesis despite her declining invasive testing
Explanation: ***Non-invasive prenatal testing (NIPT)*** - **NIPT** is the most appropriate next step for women with a **high-risk (≥1:150)** result from initial screening who decline immediate invasive procedures. - It analyzes **cell-free fetal DNA** in the mother's blood, offering a detection rate of over **99% for trisomy 21** with a very low false-positive rate. *Repeat combined screening at 16 weeks* - **Combined screening** is only valid between **11 weeks 2 days and 14 weeks 1 day** of gestation and is not repeated later in pregnancy. - Repeating the same screening test does not narrow the risk and delays further diagnostic or screening clarity. *Quadruple test at 16 weeks* - The **quadruple test** is an alternative second-trimester screening for trisomy 21 used only when **combined screening** was missed or technically impossible. - It is less accurate than the combined test and is not intended to be used as a follow-up for a **high-risk** result already obtained. *Detailed anomaly scan at 20 weeks only* - While the **middle-trimester scan** is routine for structural anomalies, it is not a primary screening tool for **trisomy 21** and cannot confirm chromosomal status. - Relying solely on this scan would ignore the current **high-risk result** of 1:85 and miss the window for earlier definitive information. *Amniocentesis despite her declining invasive testing* - **Amniocentesis** and Chorionic Villus Sampling (CVS) are diagnostic procedures that carry a risk of **miscarriage**, and patient autonomy must be respected. - Performing an **invasive procedure** against the woman's expressed wishes violates the fundamental medical principle of **informed consent**.
Question 169: A 37-year-old woman with gestational diabetes at 34 weeks gestation has growth scans showing estimated fetal weight on 95th centile with abdominal circumference on 97th centile. She has been managing with diet alone. Fasting glucose is 5.8 mmol/L and 2-hour postprandial glucose is 8.2 mmol/L. What is the most appropriate management?
- A. Continue with diet management and repeat growth scan in 2 weeks
- B. Commence metformin and continue current monitoring
- C. Commence insulin and increase monitoring frequency (Correct Answer)
- D. Arrange delivery at 37 weeks regardless of glucose control
- E. Admit for continuous glucose monitoring
Explanation: ***Commence insulin and increase monitoring frequency*** - Per **NICE guidelines**, insulin should be offered to women with GDM if blood glucose targets are not met with diet and there is evidence of **fetal macrosomia** (abdominal circumference >97th centile). - The patient's **fasting glucose (5.8 mmol/L)** and **postprandial glucose (8.2 mmol/L)** are above target thresholds, necessitating pharmacological intervention to reduce the risk of **shoulder dystocia** and birth trauma. *Continue with diet management and repeat growth scan in 2 weeks* - This approach is inappropriate because the current management has already failed to achieve **glycemic control**, as evidenced by the high glucose readings. - Delaying treatment increases the risk of **fetal hyperinsulinemia** and further acceleration of fetal growth. *Commence metformin and continue current monitoring* - While metformin is often first-line for GDM, **insulin** is specifically preferred when there is evidence of **macrosomia** or polyhydramnios reflecting suboptimal control. - The severity of current **hyperglycemia** and fetal size suggests that metformin alone may be insufficient to achieve rapid and strict control. *Arrange delivery at 37 weeks regardless of glucose control* - Delivery timing is usually individualized; however, the immediate priority is to **optimize glycemic control** to minimize risks during the remaining weeks of pregnancy. - Decisions regarding **iugr** or macrosomia-related delivery are generally made closer to term, and induction before 37 weeks is typically reserved for severe complications. *Admit for continuous glucose monitoring* - Inpatient admission is not routinely required for initiating insulin in GDM, as it can be safely managed in the **outpatient setting** with specialized nursing support. - **Continuous glucose monitoring** is an adjunct tool but does not replace the immediate need for therapeutic intervention with insulin.
Question 170: A 33-year-old woman at 24 weeks gestation is found to have a blood pressure of 152/98 mmHg at routine antenatal clinic. She is asymptomatic. Booking BP at 12 weeks was 118/76 mmHg. Urine dipstick shows trace protein. Blood tests show: creatinine 68 µmol/L, ALT 28 U/L, platelets 245 × 10⁹/L. What is the most appropriate next investigation?
- A. Urine protein:creatinine ratio (Correct Answer)
- B. 24-hour urine collection for protein quantification
- C. Renal ultrasound scan
- D. Serum uric acid level
- E. Repeat blood pressure in 4 weeks
Explanation: ***Urine protein:creatinine ratio*** - In a patient with new-onset **gestational hypertension** (BP ≥140/90 after 20 weeks), a spot **urine protein:creatinine ratio (uPCR)** is the first-line investigation to quantify proteinuria and diagnose **preeclampsia**. - NICE guidelines recommend **uPCR** because it is faster and more convenient than 24-hour collection, with a threshold of **≥30 mg/mmol** indicating significant proteinuria. *24-hour urine collection for protein quantification* - While previously the gold standard, it is no longer the first-line method because it is **prone to collection errors** and causes significant **delays in diagnosis**. - This test is now generally reserved for cases where **uPCR** results are borderline or uncertain. *Renal ultrasound scan* - This investigation is used to identify **structural renal disease**, which is not suspected here as the **serum creatinine** (68 µmol/L) is within the normal range. - It does not help in the acute diagnosis or management of **preeclampsia** or **gestational hypertension**. *Serum uric acid level* - Elevated **uric acid** can be a marker of disease severity and increased fetal risk in **preeclampsia**, but it is not a diagnostic tool for the condition itself. - It should not take priority over the quantification of **proteinuria**, which is a core diagnostic criterion. *Repeat blood pressure in 4 weeks* - Waiting four weeks is inappropriate and dangerous; new-onset hypertension after 20 weeks requires **immediate evaluation** to rule out **preeclampsia**. - Patients with a BP of 152/98 mmHg should be monitored closely, typically with **repeat measurements** within the same day or week depending on clinical severity.
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