A woman develops eclamptic convulsions at 32 weeks. After controlling seizures with magnesium sulfate, her BP remains 160/110 mmHg despite labetalol 20 mg IV twice. What is the next best antihypertensive agent?

• A Oral nifedipine 10 mg immediate release
• B IV sodium nitroprusside
• C Sublingual nifedipine
• D IV hydralazine 5 mg bolus ✓

Explanation

After labetalol failure, hydralazine 5 mg IV bolus (repeated every 20 minutes up to 20 mg) is a standard second-line agent for acute severe hypertension in pregnancy. Oral nifedipine 10 mg immediate-release is an alternative but is given orally not sublingually — sublingual nifedipine causes precipitous hypotension and is contraindicated. Sodium nitroprusside carries fetal cyanide toxicity risk and is reserved for refractory cases.

Reference: Williams Obstetrics, 26th ed.

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