A 38-year-old pregnant woman at 34 weeks presents with BP 158/104 mmHg, severe headache, and 2+ proteinuria. There is no seizure. Which antihypertensive is most appropriate for acute management in this setting?
- A IV enalapril for rapid BP reduction
- B Sublingual nifedipine 10 mg
- C IV labetalol or oral nifedipine (modified-release) ✓
- D IV sodium nitroprusside as first-line
Correct answer: C. IV labetalol or oral nifedipine (modified-release)
Explanation
Acute severe hypertension in pregnancy (SBP ≥160 or DBP ≥110 mmHg) is an obstetric emergency requiring IV labetalol, IV hydralazine, or oral nifedipine (modified-release) — all safe for fetal and maternal use. Sublingual nifedipine causes uncontrolled, precipitous BP drops and is contraindicated. ACE inhibitors and ARBs are absolutely contraindicated in pregnancy (fetal renal agenesis, oligohydramnios). Sodium nitroprusside carries fetal cyanide toxicity risk. Magnesium sulphate is used for seizure prevention (pre-eclampsia), not for BP control.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.