Osler Round 2 - 25/F at 32 weeks of gestation with severe headache

The clinical case

Nalwanga, a 25-year-old female from the Mukono, presents to the hospital at 32 weeks gestation with a complaint of sudden onset severe headache and blurred vision. She reports that the headache started 2 hours prior to arrival and has been worsening. She also mentions experiencing some epigastric pain and mild vaginal bleeding over the past 24 hours. Nalwanga has a history of one previous pregnancy that resulted in a miscarriage at 10 weeks gestation. Her past medical history is significant for hypertension, which was diagnosed during her current pregnancy. She is currently taking nifedipine 10mg twice daily for blood pressure control. Upon arrival, her vitals are: blood pressure 160/100 mmHg, pulse 110 beats per minute, respiratory rate 24 breaths per minute, oxygen saturation 98% on room air, and temperature 37.2°C. The fetal heart rate is 140 beats per minute. On examination, Nalwanga appears uncomfortable and is lying on her side. Her conjunctivae are pale, and her abdomen is tender to palpation. The uterus is palpable at the umbilicus, and fetal parts are easily palpable. Initial investigations include a complete blood count, liver function tests, and a urinalysis. The complete blood count shows a hemoglobin of 10.5 g/dL, a platelet count of 100,000/μL, and a white blood cell count of 15,000/μL. The liver function tests reveal an aspartate aminotransferase of 50 U/L and an alanine aminotransferase of 60 U/L. The urinalysis is positive for 2+ proteinuria.