Table 4.

Management of severe hypertension during pregnancy

Type of medication	Strategy
Hydralazine (IV)	5 mg IV bolus, then 10 mg every 20-30 minutes to a maximum of 25 mg, repeat in several hours as necessary
Labetalol (IV)	20 mg IV bolus over 2 minutes, then 40 mg 10 minutes later, 80 mg every 10 minutes for two additional doses to a maximum of 220 mg
Nifedipine (oral) (controversial)	10 mg po, repeat every 20 minutes to a maximum of 30 mg
Sodium nitroprusside (rarely used, usually when others fail)	0.25 μg/kg/minutes to a maximum of 5 μg/kg/minutes IV infusion Fetal cyanide poisoning may occur if used for more than 4 hours

Modified from: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Committee Opinion No. 623. American College of Obstetricians and Gynecologists (48, 49).