--- title: 37 Week Gestation with Hypertension description: It's Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/QUIZ%20TIME.png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/37-week-gestation-with-hypertension#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) quick quiz # 37 Week Gestation with Hypertension It's Quiz Time with Med-Challenger! [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Oct 27, 2024 [obgyn](https://challengercme.com/blog/tag/obgyn) [Personal Education](https://challengercme.com/blog/tag/personal-education) [Question of the Week](https://challengercme.com/blog/tag/question-of-the-week) [quick quiz](https://challengercme.com/blog/tag/quick-quiz) ### < [All Posts](https://challengercme.com/blog) Try Med-Challenger Start a free trial today and save! Pass-guaranteed board exam review with CME/CE credits built-in. Target weak areas, study smarter, stay on track. Act now and save. [BROWSE COURSES](https://fuse.challengercme.com/store) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/37-week-gestation-with-hypertension&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/37-week-gestation-with-hypertension&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/37-week-gestation-with-hypertension&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/37-week-gestation-with-hypertension&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![37 Week Gestation with Hypertension](https://challengercme.com/hubfs/QUIZ%20TIME.png) A 35-year-old, gravida 2 para 1001 woman at 37.6 weeks of gestation presents for her antenatal check. She states that she has been having constant headaches for the last 2 days. She tells you that she has gained 5 pounds in the last week. Upon examination, her blood pressure is 154/102 mm Hg. Urine drip reveals 2+ protein. You repeat the blood pressure readings 20 minutes later, and her blood pressure reading is 158/98 mm Hg.   Which of the following is the most appropriate next step in this patient's treatment plan? - Start her on antihypertensive medications and start laboratory work. - Induce the patient. - Perform amniocentesis for confirming fetal lung maturity. - Give her steroids. The correct answer is: This patient should be induced. It would be reasonable to prescribe steroids for women whose gestational age is less than 34 weeks, administer a course of antenatal corticosteroids, and provide frequent blood pressure, laboratory, and fetal monitoring in the hospital. If the patient's blood pressure is easily controlled with medication, she does not develop pre-eclampsia, and the fetus remains healthy, then delivery at 34 to 36 weeks is reasonable. However, this patient is at 37.6 weeks, and, at this gestational age, fetal lung maturity does not need to be established. The Table below explains guidelines from the American College of Obstetricians and Gynecologists for inducing labor in patients who are newly diagnosed with pre-eclampsia. ## Chronic Hypertension | **Controlled on no medications** | Early term/term | 38 0/7–39 6/7 weeks of gestation | | --- | --- | --- | | **Controlled on medications** | Early term/term | 37 0/7–39 6/7 weeks of gestation | | **Difficult to control** | Late preterm/early term | 36 0/7–37 6/7 weeks of gestation | | **Gestational hypertension** | Early term | 37 0/7–38 6/7 weeks of gestation | | **Preeclampsia—severe** | Late preterm | At diagnosis after 34 0/7 weeks of gestation | | **Preeclampsia—mild** | Early term | At diagnosis after 37 0/7 weeks of gestation | For medically indicated early delivery of a neonate, there is no need to perform amniocentesis to determine fetal lung maturity. The patient will require amniocentesis for fetal lung maturity if the early delivery is being considered for reasons not medically indicated. Acute-onset, severe hypertension that is accurately measured using standard techniques and is persistent for 15 minutes or more is considered a hypertensive emergency. Severe-onset hypertension may occur in the second half of gestation in women not known to have chronic hypertension who develop sudden, severe hypertension (ie, with pre-eclampsia, gestational hypertension, or HELLP syndrome), but it can also occur among patients with chronic hypertension who are developing superimposed pre-eclampsia with acutely worsening, difficult-to-control, severe hypertension. It is well known that severe hypertension can cause injury to the central nervous system. The degree of systolic hypertension (as opposed to the level of diastolic hypertension or relative increase or rate of increase of mean arterial pressure from baseline levels) may be the most important predictor of cerebral injury and infarction. In a case series of 28 women with severe pre-eclampsia and stroke, all but 1 woman had severe systolic hypertension prior to hemorrhagic stroke. A total of 54% died, whereas only 13% had severe diastolic hypertension in the hours preceding stroke. A similar relationship between severe systolic hypertension and risk of hemorrhagic stroke has been observed in nonpregnant adults. Thus, systolic blood pressure of 160 mm Hg or higher is included as part of the definition of severe hypertension in pregnant women or women in the postpartum period. **References:** Abdul Sultan A, West J, Tata LJ, et al. Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England. *BMJ*. 2013;347:f6099. American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. *Obstet Gynecol*. 2013;121(4):908-910. Broekhuijsen K, van Baaren GJ, van Pampus MG, et al. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. *Lancet*. 2015;385:2492. Crowther CA, Bouwmeester AM, Ashurst HM. Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non-proteinuric hypertension? *Br J Obstet Gynaecol.* 1992;99:13. Henderson JT, et al. *Low-Dose Aspirin for the Prevention of Morbidity and Mortality From Preeclampsia: A Systematic Evidence Review for the U.S. Preventive Services Task Force*. 2014. Maloney KF, Heller D, Baergen RN. Types of maternal hypertensive disease and their association with pathologic lesions and clinical factors. *Fetal Pediatr Pathol*. 2012;31:319.   This question appears in [Med-Challenger OBGYN Review with CME](https://challengercme.com/obgyn-exam-review-cme-course) [![subcription_icon_obgyn-e1519157412939](https://challengercme.com/hs-fs/hubfs/Imported_Blog_Media/subcription_icon_obgyn-e1519157412939.png?width=250&height=256&name=subcription_icon_obgyn-e1519157412939.png)](https://challengercme.com/obgyn-exam-review-cme-course) [![QuizButton-1](https://challengercme.com/hs-fs/hubfs/QuizButton-1.jpg?width=235&height=81&name=QuizButton-1.jpg)](https://challengercme.com/blog/infant-with-micrognathia-and-high-arched-palate) --- No matter your program, no matter the size, [Med-Challenger for Groups and Institutions](https://challengercme.com/institutional-medical-education-for-groups) can better prepare your program or group, fulfill industry requirements, and increase test scores.   For personal medical education that includes board's prep, MOC, and CME requirements, Med-Challenger has you covered in [Family Medicine](https://challengercme.com/family-medicine-exam-review-cme-courses), [Emergency Medicine](https://challengercme.com/emergency-medicine-exam-review-cme-courses), [Internal Medicine](https://challengercme.com/internal-medicine-exam-review-cme-courses), [Pediatrics](https://challengercme.com/pediatric-medicine-exam-review-cme-courses), [Pediatric Emergency Medicine](https://challengercme.com/category-pediatric-emergency-medicine-courses), [OBGYN](https://challengercme.com/obgyn-exam-review-cme-courses), [Physician Assistants](https://challengercme.com/physician-assistant-exam-review-cme-courses), and [Nurse Practitioners.](https://challengercme.com/nurse-practitioner-exam-review-cme-courses)   Never miss a thing. Subscribe to our blog and save! [![SUBSCRIBE Medical Education Blog & Newsletter](https://no-cache.hubspot.com/cta/default/9106197/703c79e6-b750-4dfa-acfa-b6ca5307c563.png)](https://cta-redirect.hubspot.com/cta/redirect/9106197/703c79e6-b750-4dfa-acfa-b6ca5307c563)   ## Similar posts internal medicine ### [A 62-year-old woman was hit by a ball while playing tennis](https://challengercme.com/blog/a-62-year-old-woman-was-hit-by-a-ball-while-playing-tennis) It's Neurology Issues in ICU Quiz Time with Med-Challenger! Med-Challenger Nov 25, 2024 internal medicine ### [A 62-year-old woman was admitted with an episode of aspiration pneumonia](https://challengercme.com/blog/a-62-year-old-woman-was-admitted-with-an-episode-of-aspiration-pneumonia) It's Gastro Quiz Time with Med-Challenger! Med-Challenger Feb 3, 2025 emergency medicine ### [A 32-year-old woman with diabetes presents with a 3 days history of erythema, warmth, edema and pain of her forearm](https://challengercme.com/blog/a-32-year-old-woman-with-diabetes-presents-with-a-3-days-history-of-erythema-warmth-edema-and-pain-of-her-forearm) It's Cutaneous Disorders Quiz Time with Med-Challenger! Med-Challenger Jan 22, 2025 ## Stay informed. ### Subscribe to our [Medical Education Blog](https://challengercme.com/blog)  Stay informed of new medical education content, certification requirements and deadlines, case-based CME quizzes, and special offers. [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com) #### **Online Medical Education** 1-800-676-0822 Sales - Option 1 Support - Option 2   ### Company - [Get Support](https://support.challengercme.com/knowledge/kb-tickets/new) - [Policies](https://support.challengercme.com/knowledge) - [Special Offers](https://challengercme.com/special) ### Products - [Exam Prep & CME](https://challengercme.com/med-challenger-free-trial-landing-page) - [Institutional LMS](https://challengercme.com/atlas-pro-inst) ### Resources - [CME Blog](https://challengercme.com/blog) - [Knowledge Base](https://support.challengercme.com/knowledge) ### Account - [Create Account](https://fuse.challengercme.com/sign-up) - [Login](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) © 2026 Challenger Corporation. All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "gestational hypertension", "preeclampsia", "severe hypertension in pregnancy", "induction of labor", "antenatal corticosteroids", "fetal lung maturity", "hypertensive emergency", "HELLP syndrome", "blood pressure monitoring in pregnancy", "obstetrics exam preparation" ], "articleSection" : "Obstetrics", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2024-11-08T21:36:53.883Z", "datePublished" : "2024-10-27T15:00:00.000Z", "description" : "It's Quiz Time with Med-Challenger!", "headline" : "37 Week Gestation with Hypertension", "image" : [ { "@type" : "ImageObject", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation", "name" : "Med-Challenger Medical Education, a Division of Challenger Corporation" } ], "inLanguage" : "en-US", "keywords" : [ "pre-eclampsia", "gestational hypertension", "induction", "antenatal corticosteroids", "fetal lung maturity", "severe hypertension", "systolic blood pressure", "HELLP", "obstetrics", "labor induction guidelines" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/37-week-gestation-with-hypertension", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Induce the patient. At 37.6 weeks' gestation with hypertension and proteinuria consistent with pre-eclampsia, delivery is appropriate. Antenatal corticosteroids are generally reserved for gestational ages under 34 weeks; amniocentesis to assess fetal lung maturity is not required when delivery is medically indicated; blood pressure and fetal monitoring and labs are part of inpatient care, but induction is the most appropriate next step at this gestational age." }, "name" : "Most appropriate next step for a patient at 37.6 weeks with hypertension and proteinuria?", "text" : "A 35-year-old, gravida 2 para 1001 woman at 37.6 weeks of gestation presents with 2 days of constant headaches, a 5-pound weight gain in the last week, blood pressure 154/102 mm Hg with repeat reading 158/98 mm Hg, and urine dip showing 2+ protein. Which of the following is the most appropriate next step in this patient's treatment plan? Choices: Start her on antihypertensive medications and start laboratory work; Induce the patient; Perform amniocentesis for confirming fetal lung maturity; Give her steroids." } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Induce the patient — at 37.6 weeks with findings consistent with pre-eclampsia, delivery is appropriate; steroids for lung maturity are generally not needed at this gestational age." }, "name" : "At 37.6 weeks with hypertension and proteinuria, what is the most appropriate next step?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "No — the article states steroids are reasonable for women whose gestational age is less than 34 weeks; at 37.6 weeks they are not indicated for fetal lung maturation." }, "name" : "Are antenatal corticosteroids indicated at 37.6 weeks for this patient?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "No — for medically indicated early delivery there is no need to perform amniocentesis to determine fetal lung maturity; it is only required if early delivery is not medically indicated." }, "name" : "Is amniocentesis to confirm fetal lung maturity required when delivery is medically indicated?" }, "position" : 3 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "A systolic blood pressure of 160 mm Hg or higher is included as part of the definition of severe hypertension in pregnant and postpartum women." }, "name" : "What systolic blood pressure threshold is included in the definition of severe hypertension in pregnancy?" }, "position" : 4 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "When severe hypertension is accurately measured using standard techniques and is persistent for 15 minutes or more, it is considered a hypertensive emergency." }, "name" : "When is acute-onset severe hypertension considered a hypertensive emergency in pregnancy?" }, "position" : 5 } ], "name" : "Practice Questions", "numberOfItems" : 5 } ```