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Severe HTN

  • Inpatient care if severe HTN/preeclampsia

  • Lower BP to SBP <160 mmHg & DBP <110

    • Initial Rx in hospital

      • Labetalol 10-80 mg IV q30 min prn or 200 mg po q60 min prn or IV infusion (0.5-2 mg/min)

      • Short-acting nifedipine capsules 5-10 mg po q30-60 min prn

      • Methyldopa 1000 mg po

      • Hydralazine 5-10 mg IV q30 min prn

    • Alternatives: NTG infusion, po clonidine

      • Postpartum: po captopril

    • 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  mmHg ≤85 mmHg

    • Labetalol 100-300 mg po tid-qid

    • Nifedipine XL 30-60 mg po od (or 30 mg po bid)

    • Methyldopa 250-750 po tid-qid

  • No ACE-Is or ARBs in pregnancy

Non-severe w/ comorbid conditions

  • Lower BP to SBP <140 mmHg & DBP <85 mmHg

    • Same Rx as above

  • Captopril, enalapril, or quinapril ok postpartum (even if breastfeeding)

Reference: Magee LA, Smith GN, Bloch C, et al. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. J Obstet Gynaecol Can. 2022;44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002

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