Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Acute-Onset, Severe Hypertension During Pregnancy

Obstet Gynecol; ePub 2017 Mar 24; O’Neil Eckert, et al

Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension, severe diastolic hypertension, or both, require urgent antihypertensive therapy. The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion on this topic, offering both recommendations and conclusions, including:

  • Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes.
  • Close maternal and fetal monitoring by a physician and nursing staff are advised during the treatment of acute-onset, severe hypertension.
  • After initial stabilization, the team should monitor blood pressure closely and institute maintenance therapy as needed.
  • Intravenous (IV) labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period.
  • Immediate release oral nifedipine also may be considered as a first-line therapy, particularly when IV access is not available.
  • The use of IV labetalol, IV hydralazine, or immediate release oral nifedipine for the treatment of acute-onset, severe hypertension for pregnant or postpartum patients does not require cardiac monitoring.


Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Committee Opinion No. 692. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017:129:e90–5.