Pregnancy-Induced Hypertension MCQ — NEET PG Practice Question | NEETPGAI
Pregnancy-Induced Hypertension
hard
baby OBG
A 32-year-old multiparous woman at 28 weeks of gestation is diagnosed with severe preeclampsia (BP 165/110 mmHg, proteinuria 3+, epigastric pain). She is not in labor and has no contraindications to oral therapy. Which antihypertensive is the preferred choice for immediate BP reduction while awaiting transfer to a tertiary center?
A. Intravenous hydralazine
B. Sublingual nifedipine
C. Oral immediate-release nifedipine
D. Oral labetalol
Explanation
Antihypertensive Choice in Severe Preeclampsia (Acute BP Reduction)
Key Point
For acute severe hypertension in preeclampsia (BP ≥160/110 mmHg), oral immediate-release nifedipine is a first-line recommended agent per ACOG 2022 guidelines, regardless of whether the patient is in labor. The goal is to reduce BP within 30–60 minutes to prevent maternal stroke and placental abruption.
Acute severe-range BP requiring prompt treatment (within 30–60 min per ACOG)
Oral therapy is feasible — oral immediate-release nifedipine is the appropriate choice
ACOG 2022 Recommended Agents for Acute Severe Hypertension in Pregnancy
Table
Drug
Route
Dose
Onset
Notes
Oral immediate-release nifedipine
Oral
10–20 mg, repeat q20–30 min
10–20 min
First-line oral agent; ACOG-recommended
IV labetalol
IV
20–80 mg bolus
5–10 min
First-line IV agent
IV hydralazine
IV
5–10 mg bolus
10–20 min
Acceptable IV alternative
High-YieldNEET PG
ACOG (2022 Hypertension in Pregnancy) explicitly recommends oral immediate-release nifedipine as a first-line agent for acute severe hypertension in pregnancy when IV access is not immediately available or oral therapy is preferred. It is NOT the same as sublingual nifedipine.
Why NOT the Other Options?
Oral labetalol (option C):
Oral labetalol has a slow onset (2–4 hours) and is used for maintenance/chronic antihypertensive therapy in pregnancy, not for acute severe-range BP reduction
ACOG does not list oral labetalol as a recommended agent for acute severe hypertension management — only IV labetalol is recommended for acute use
Using oral labetalol in this acute setting would delay BP control and risk maternal stroke
Intravenous hydralazine (option B):
IV hydralazine is an acceptable agent for acute severe hypertension, but the stem specifies oral therapy is feasible
When oral therapy is available, oral immediate-release nifedipine is preferred over IV hydralazine due to ease of administration and comparable efficacy
Sublingual nifedipine (option D):
Sublingual administration causes unpredictable, precipitous BP drops due to erratic absorption
Associated with maternal stroke, placental abruption, and fetal hypoxia
Contraindicated in modern obstetric practice; ACOG explicitly recommends against it
Distinct from oral immediate-release nifedipine (option A), which is swallowed and has predictable pharmacokinetics
Clinical Pearl
Critical distinction: Oral immediate-release nifedipine (swallowed, 10 mg capsule) ≠ sublingual nifedipine (bitten/placed under tongue). The oral route provides controlled absorption and is ACOG-endorsed for acute severe hypertension in pregnancy. The sublingual route is dangerous and obsolete.
Mnemonic for acute severe hypertension in pregnancy (ACOG 2022):
Nifedipine oral IR — first-line oral
Labetalol IV — first-line IV
Hydralazine IV — acceptable IV alternative
Sublingual nifedipine — NEVER
ACOG Practice Bulletin No. 222, 2020 (reaffirmed 2022) — Gestational Hypertension and Preeclampsia, ACOG Committee Opinion 767 — Emergent Therapy for Acute-Onset Severe Hypertension During Pregnancy, Harrison's Principles of Internal Medicine, 21e, Ch. 427
Practice similar questions
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.
