A 23-Year-Old Primigravida at 32 Weeks Gestation Is Brought to the Emergency

A 23-year-old primigravida at 32 weeks gestation is brought to the emergency department by her mother due to a seizure that occurred 30 minutes ago.  The mother states her daughter was eating lunch at a restaurant and "suddenly started shaking her arms and legs."  During the 45-second episode, the patient's head moved from side to side and her eyes fluttered.  The patient has no chronic medical conditions, and her pregnancy has been uncomplicated.  Temperature is 37.4 C (99.3 F) , blood pressure is 128/84 mm Hg, and pulse is 82/min.  The patient is alert and fully oriented.  Cardiopulmonary examination is normal.  Neurologic examination demonstrates no abnormalities.  When the abdomen is palpated, the patient states she is not feeling well and suddenly starts to have rhythmic, asynchronous movements of the upper and lower extremities.  The jaw is clenched, and the patient does not respond to questions or follow commands.  The episode resolves within 1 minute and the patient is alert and oriented.  Repeat blood pressure is 116/74 mm Hg.  Fetal heart rate tracing has a baseline of 150/min, moderate variability, and no decelerations.  Complete blood count, basic metabolic panel, and urinalysis show no abnormalities.  Urine drug screen is negative.  Which of the following is the best next step in management of this patient?

A) 24-hour urine protein collection
B) Carbamazepine
C) Emergency cesarean delivery
D) Immediate induction of labor
E) Magnesium sulfate
F) Video electroencephalogram

Correct Answer:

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