Severe pre-eclampsia — stabilisation and delivery planning OSCE

Candidate instructions

Stabilise severe pre-eclampsia and outline next steps including magnesium and timing of birth.

Candidate tasks

1. ABC, left lateral tilt, senior help, continuous monitoring.
2. Control BP with labetalol or nifedipine (avoid ACE inhibitors).
3. Start magnesium sulfate seizure prophylaxis (loading + maintenance).
4. Send PET bloods, CTG, urine protein assessment.
5. Plan corticosteroids if preterm and discuss delivery as definitive treatment.

Examiner checklist

• Recognises severe features (BP, symptoms, clonus/hyperreflexia)
• Antihypertensive with dose route
• MgSO4 regimen (e.g. 4 g IV load then 1 g/h) and toxicity watch (reflexes, RR, urine output)
• Calcium gluconate as antidote for Mg toxicity
• Delivery is definitive cure; timing individualised after stabilisation
• Fluid restriction / careful fluids; watch pulmonary oedema
• Postpartum surveillance mentioned

Model standard

Stabilise mother first (BP + MgSO4), assess fetus, give steroids if time, deliver when safe — especially if unstable, eclampsia, HELLP, or fetal compromise. Continue Mg often 24 h postpartum.

Common errors

• Delivering before stabilising BP/Mg
• Fluid overload
• Missing Mg toxicity monitoring