Pre-Eclampsia Hypertensive Emergency — RACP Adult Medicine MCQ

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ModerateCardiologyPre-Eclampsia Hypertensive EmergencyRACP Adult Medicine

A 30-year-old woman at 36 weeks gestation presents with BP 190/120 mmHg, severe headache, visual disturbance, and epigastric pain. She has 3+ proteinuria and hyperreflexia. She has not had a seizure. What is the most appropriate antihypertensive and seizure prophylaxis?

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Correct answer: E — MAP reduction 25% over first hour

Pre-eclampsia with severe features requires: (1) IV labetalol or IV hydralazine for BP control (target <160/110 acutely), (2) IV magnesium sulfate for seizure prophylaxis (MAGPIE trial — 4 g loading dose then 1 g/hr), and (3) urgent delivery planning. ACEi/ARBs are contraindicated in pregnancy. Among options, 25% MAP reduction over first hour is the closest match to the acute BP management goal in hypertensive emergency. [Note: pregnancy-specific target is <160/110]

Reference: SOMANZ – 2023 – Hypertension in Pregnancy; MAGPIE Trial