A 27-year-old woman at 35 weeks gestation presents with BP 162/108 mmHg, 3+ proteinuria, and platelets 110,000/µL. She is diagnosed with pre-eclampsia with severe features. Which of the following antihypertensive regimens is most appropriate for acute blood pressure control?
- A IV labetalol 20 mg bolus, repeat with 40 mg then 80 mg every 10 minutes as needed ✓
- B Oral nifedipine 10 mg stat, repeat every 30 minutes as needed
- C IV sodium nitroprusside infusion titrated to effect
- D Sublingual nitroglycerin spray
Correct answer: A. IV labetalol 20 mg bolus, repeat with 40 mg then 80 mg every 10 minutes as needed
Explanation
IV labetalol is a first-line agent for acute severe hypertension in pregnancy per ACOG and Indian guidelines, with a standard bolus protocol of 20 mg, then 40 mg, then 80 mg IV every 10 minutes as needed. Oral nifedipine is also used but IV labetalol has a more predictable onset. Sodium nitroprusside is reserved for refractory cases due to fetal cyanide toxicity risk. Sublingual nitroglycerin is not standard for this indication.
Reference: Williams Obstetrics, 26th ed.
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