A 34th week pregnant woman was admitted to a maternity ward with hyper emesis gravid arum. At the time of admission, her blood pressure was 90/50mmHg . Pulse rate was 100/min and she was vomiting frequently. She had dry mouth and poor concentration. Her lab investigation results show that 3+ ketone in urine, 2+ proteins and her HCT is 35 percent. What is the most appropriate management for this woman? a. Terminate the pregnancy b. Start RL with 40 percent dextrose c. Start NG tube feeding d. Put the woman on NPO

The most appropriate management for this woman would be to start RL (intravenous rehydration) with 40 percent dextrose. This is because she is experiencing hyperemesis gravidarum, which is severe nausea and vomiting during pregnancy that can lead to dehydration and electrolyte imbalances. The presence of 3+ ketones in her urine indicates that her body is using fat for energy due to lack of carbohydrates, which can lead to ketoacidosis if not treated. Starting RL with 40 percent dextrose will help to rehydrate her and provide her with the necessary carbohydrates to prevent further ketosis. Additionally, her low hematocrit (HCT) level indicates that she is anemic, which can be a complication of hyperemesis gravidarum. Therefore, starting RL with 40 percent dextrose is the most appropriate management for this woman.