Treatment

Severe HTN
- Inpatient care if severe HTN/preeclampsia
- Lower BP to SBP <160 mmHg & DBP <110
  - Initial Rx in hospital
    - Short-acting nifedipine capsules 5-10 mg po q30 min prn
    - Hydralazine 5-10 mg IV q30 min prn
    - Labetalol 20-80 mg IV q30 min prn
  - Alternatives: NTG infusion, po methyldopa, po labetalol, po clonidine
    - Postpartum: po captopril
  - Refractory HTN: SNP
  - Nifedipine & MgSO4 can be used contemporaneously
  - MgSO4 not recommended as sole anti-HTN Rx
- Continuous FHR monitoring until BP stable
Non-severe (SBP 140-159 mmHg, DBP 90-109 mmHg) w/o comorbid conditions
- Lower BP to SBP 130-155 mmHg & DBP 80-105 mmHg
  - Methyldopa 250-500 po bid-qid
  - Labetalol 100-400 mg po bid-tid
  - Nifedipine XL 20-60 mg po od
- No ACE-Is or ARBs in pregnancy
- Atenolol & prazosin not recommended prior to delivery
Non-severe w/ comorbid conditions
- Lower BP to SBP <140 mmHg & DBP <90 mmHg
  - Same Rx as above
- Captopril, enalapril, or quinapril ok postpartum (even if breastfeeding)

Adapted from SOGC Clinical Practice Guideline. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary. J Obstet Gynaecol Can 2014;36(5):416–438