What is a contraindication to expectant management of preeclampsia with severe features?

Expectant management of preeclampsia with severe features involves closely monitoring the mother and fetus while delaying delivery as long as it is safe to do so. However, uncontrollable hypertension is a key contraindication to this approach. When blood pressure remains excessively high despite treatment, it significantly increases the risk of serious complications for both the mother and the fetus, including stroke or placental abruption. Therefore, if hypertension cannot be managed effectively, the risks associated with continuing the pregnancy outweigh the benefits of expectant management, necessitating timely delivery to safeguard the health of both the mother and the baby.

The other options, while they may indicate concerns in the management of preeclampsia, do not represent absolute contraindications to expectant management. Severe headache can be a symptom of worsening preeclampsia that requires evaluation but is not solely a contraindication. Gestational diabetes is a separate condition that can complicate pregnancy but is not a direct contraindication to expectant management of preeclampsia. Low birth weight is also not a definitive reason to avoid expectant management, as outcomes can vary, and every effort is often made to prolong gestation if possible while managing the associated risks.