A pregnant woman at 33 weeks presents with severe headache and hypertension. What is the appropriate next step in management?

In the case of a pregnant woman presenting at 33 weeks with severe headache and hypertension, the appropriate next step in management is to administer magnesium sulfate. This approach is particularly important because the clinical scenario suggests the possibility of severe hypertension or potential preeclampsia, both of which can lead to complications if not managed promptly.

Magnesium sulfate serves as a prophylactic treatment against seizures in patients with severe preeclampsia or eclampsia. The severe headache and hypertension indicate that the woman may be at risk for hypertensive-related complications, including seizures. Administering magnesium sulfate helps to protect against these risks and stabilizes the patient while other necessary assessments and interventions can be carried out.

It’s essential to recognize that the other options are not appropriate immediate interventions in this situation. Discharging the patient would neglect the potential severity of her condition, a CT scan may be inappropriate given the possibility of preeclampsia, and starting IV fluids alone would not address the immediate risk of seizures associated with severe hypertension. Therefore, the initiation of magnesium sulfate is the correct and most critical step in this context.