In acute severe hypertension in pregnancy (systolic ≥ 160 or diastolic ≥ 110 mmHg), which medication is the FIRST-LINE treatment per ACOG 2022 guidance?
- A Oral nifedipine 10 mg immediate release
- B IV hydralazine 5 mg bolus
- C IV labetalol 20 mg bolus
- D Either IV labetalol, IV hydralazine, or oral nifedipine are first-line; no single agent is preferred ✓
Correct answer: D. Either IV labetalol, IV hydralazine, or oral nifedipine are first-line; no single agent is preferred
Explanation
ACOG 2022 Hypertension in Pregnancy guidelines state that three agents are first-line and equivalent for acute severe hypertension: IV labetalol (20 mg then 40 mg, 80 mg escalating), IV hydralazine (5–10 mg bolus every 20 min), or oral nifedipine immediate release (10–20 mg every 20 min). The target is to lower BP to ≤ 150/100 mmHg within 30–60 minutes. Choice depends on clinical context and contraindications (labetalol is contraindicated in asthma).
Reference: Williams Obstetrics, 26th ed.
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