Hypertensive Emergency in Pregnancy — DRCOG MCQ
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Correct answer: A — IV labetalol or IV hydralazine, or oral immediate-release nifedipine to treat to <160/110 promptly
This patient has acute severe-range hypertension in pregnancy (SBP ≥160 mmHg or DBP ≥110 mmHg) with headache, consistent with preeclampsia with severe features until proven otherwise. Severe-range BP is an obstetric hypertensive emergency because of maternal stroke and end-organ injury risk. Immediate management is rapid antihypertensive treatment with a first-line agent: IV labetalol, IV hydralazine, or oral immediate-release nifedipine, with repeat BP checks and dose escalation to bring BP below the severe range (<160/<110 mmHg) promptly. Observation is unsafe, ACE inhibitors are contraindicated in pregnancy, diuretics alone are not appropriate acute therapy, and thrombolysis has no role in preeclampsia management.
Reference: American College of Obstetricians and Gynecologists (ACOG). Acute Hypertension in Pregnancy & Postpartum Algorithm. 2024. https://www.acog.org/-/media/project/acog/acogorg/files/pdfs/programs/ob-emergencies/hypertension_algorithm.pdf