According to ACOG 2020 guidelines, which antihypertensive drug is considered FIRST-LINE for acute severe hypertension in pregnancy and postpartum due to its rapid onset, predictable dose-response, and proven safety profile?
- A IV Hydralazine
- B Oral Nifedipine (immediate-release)
- C IV Labetalol ✓
- D IV Nicardipine
Correct answer: C. IV Labetalol
Explanation
ACOG 2020 recommends IV labetalol, IV hydralazine, or oral immediate-release nifedipine as first-line agents for acute severe hypertension in pregnancy. However, labetalol is often preferred for its cardioselective beta-1 blockade plus alpha-1 blockade, predictable titration, and minimal placental transfer. Hydralazine has more unpredictable response and risk of maternal hypotension. Nifedipine is an acceptable oral alternative. Nicardipine is used as a second-line agent. The goal is to bring BP to <160/110 within 30-60 minutes.
Reference: Williams Obstetrics, 26th ed.
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