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Chronic hypertension in pregnancy — USMLE Step 3 MCQ

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HardOB/GYNChronic hypertension in pregnancyUSMLE Step 3

A patient with chronic hypertension presents at 14 weeks gestation with controlled BP on labetalol, no proteinuria and normal renal function. Which preventive medication should be started now?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Begin low-dose aspirin now and continue until delivery

The best answer is “Begin low-dose aspirin now and continue until delivery”. Chronic hypertension is a high-risk factor for preeclampsia, so low-dose aspirin prophylaxis should begin between 12 and 28 weeks, ideally before 16. Enoxaparin needs another indication. Excessive blood-pressure lowering, ACE inhibition, or preterm delivery without complication are inappropriate.

Reference: ACOG, Low-Dose Aspirin Use During Pregnancy: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/07/low-dose-aspirin-use-during-pregnancy