From the Guidelines
The most appropriate treatment for severe hypertension during active labor, with a blood pressure of 146/110, is the immediate administration of intravenous labetalol or hydralazine to lower blood pressure and prevent complications, as recommended by the most recent and highest quality study 1.
Key Considerations
- The goal is to maintain systolic blood pressure between 140-150 mmHg and diastolic between 90-100 mmHg, avoiding excessive drops that could compromise uteroplacental perfusion.
- Continuous maternal and fetal monitoring is essential during treatment.
- Magnesium sulfate should be administered for seizure prophylaxis if preeclampsia is present.
Treatment Options
- Labetalol: 20-40 mg IV initially, then 40-80 mg every 10-15 minutes as needed, maximum 300 mg.
- Hydralazine: 5-10 mg IV every 20-30 minutes as needed.
- Nifedipine: 10-20 mg orally every 30 minutes, although its use is generally discouraged due to the risk of uncontrolled hypotension, particularly when combined with magnesium sulfate.
Rationale
The treatment of severe hypertension during active labor is crucial to prevent complications such as stroke, placental abruption, and other serious maternal and fetal complications. The most recent and highest quality study 1 recommends the use of intravenous labetalol or hydralazine as first-line agents, with nifedipine as an alternative option. The goal of treatment is to maintain a safe blood pressure range while avoiding excessive drops that could compromise uteroplacental perfusion.
Additional Recommendations
- Antihypertensive treatment should be continued during labor and delivery to keep SBP < 160 mmHg and DBP < 110 mmHg, as recommended by 1.
- Women with preeclampsia should be delivered promptly, either vaginally or by caesarean section, regardless of gestational age, as recommended by 1.
From the FDA Drug Label
Labetalol HCl Injection is indicated for control of blood pressure in severe hypertension. In a clinical pharmacologic study in severe hypertensives, an initial 0. 25 mg/kg injection of labetalol HCl, administered to patients in the supine position, decreased blood pressure by an average of 11/7 mmHg.
For a blood pressure of 146/110 during active labor, labetalol (IV) can be considered for treatment of severe hypertension. The initial dose is typically 0.25 mg/kg, which may be repeated as needed to achieve the desired effect. It is essential to monitor the patient's blood pressure and adjust the dosage accordingly. 2 2
From the Research
Treatment for Severe Hypertension during Active Labor
For a blood pressure of 146/110 during active labor, the following treatment options can be considered:
- Nifedipine, labetalol, and hydralazine are commonly used as first-line therapies for severe hypertension in pregnancy 3
- Magnesium sulfate combined with nifedipine and labetalol has been shown to be effective in reducing blood pressure and improving maternal and fetal outcomes 4, 5
- Labetalol and nifedipine can be used in combination with magnesium sulfate to control blood pressure and prevent complications 5, 6
Medication Options
Some medication options for severe hypertension during active labor include:
- Nifedipine: effective in reducing blood pressure, especially when used as a single dose 3
- Labetalol: can be used in combination with magnesium sulfate to control blood pressure and improve outcomes 4, 5, 6
- Hydralazine: effective in reducing blood pressure, especially when used in combination with other medications 3
Considerations
When treating severe hypertension during active labor, it is essential to consider the following:
- The goal of treatment is to reduce blood pressure and prevent complications while minimizing risks to the mother and fetus 3, 4, 5
- Close monitoring of blood pressure and fetal well-being is crucial during treatment 7
- The choice of medication and treatment plan should be individualized based on the patient's specific needs and medical history 3, 4, 5, 6