From the Guidelines
The treatment for maternal hypertension in labor should prioritize controlling blood pressure with intravenous labetalol or oral nifedipine as first-line therapy, aiming to maintain systolic blood pressure between 140-150 mmHg and diastolic between 90-100 mmHg, while ensuring maternal and fetal safety, as recommended by the most recent guidelines 1. The goal of treatment is to prevent complications such as stroke, pulmonary edema, and eclampsia, while also ensuring the well-being of the fetus.
- Key considerations in managing maternal hypertension in labor include:
- Monitoring blood pressure closely and initiating treatment promptly if systolic blood pressure exceeds 160 mmHg or diastolic blood pressure exceeds 110 mmHg 1
- Using intravenous labetalol or oral nifedipine as first-line therapy, with hydralazine as an alternative option 1
- Administering magnesium sulfate for severe hypertension or preeclampsia with severe features to prevent seizures 1
- Restricting fluid management to prevent pulmonary edema, typically limiting intake to 80-100 mL/hour 1
- Considering delivery of the baby and placenta as the definitive treatment, with induction of labor or cesarean delivery as necessary depending on maternal condition, gestational age, and fetal status 1 These recommendations are based on the most recent and highest-quality evidence, prioritizing the safety and well-being of both the mother and the fetus 1.
From the FDA Drug Label
Labetalol given to pregnant women with hypertension did not appear to affect the usual course of labor and delivery. The treatment for maternal hypertension in labor may involve labetalol, as it has been used in pregnant women with hypertension without affecting the usual course of labor and delivery 2.
- Key considerations:
- Hypotension, bradycardia, hypoglycemia, and respiratory depression have been reported in infants of mothers treated with labetalol for hypertension during pregnancy.
- Labetalol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
From the Research
Treatment for Maternal Hypertension in Labor
- The treatment for maternal hypertension in labor typically involves the use of antihypertensive medications to reduce blood pressure and prevent complications such as stroke 3.
- According to the ACOG Committee Opinion No. 767, first-line agents for the management of acute-onset, severe hypertension in pregnant women include intravenous labetalol, hydralazine, and immediate-release oral nifedipine 3.
- A systematic review of oral antihypertensive agents for the treatment of severe pregnancy/postpartum hypertension found that nifedipine, labetalol, and methyldopa are suitable options for treatment 4.
- A randomized control trial comparing the effectiveness of nifedipine, labetalol, and hydralazine in reducing blood pressure in severe preeclampsia found that nifedipine was the most effective drug for single-dose administration, while hydralazine was the most effective for triple-dose administration 5.
- A retrospective cohort study found that initial treatment with oral nifedipine was associated with a higher likelihood of resolution of severe hypertension within 60 minutes of treatment compared to intravenous labetalol 6.
- A real-world cohort study of patients diagnosed with a hypertensive disorder of pregnancy found that labetalol, nifedipine, and hydralazine were the most commonly used antihypertensive medications, and that increasing severity of hypertensive disorder was associated with a higher likelihood of antihypertensive use 7.
Antihypertensive Medications
- Labetalol: a commonly used antihypertensive medication for the treatment of maternal hypertension in labor 3, 4, 7.
- Nifedipine: an effective medication for reducing blood pressure in severe preeclampsia, particularly for single-dose administration 4, 5, 6.
- Hydralazine: a first-line agent for the management of acute-onset, severe hypertension in pregnant women, and the most effective medication for triple-dose administration in severe preeclampsia 3, 5, 7.
- Methyldopa: a suitable option for the treatment of severe hypertension in pregnancy, although it is used less frequently than other medications 4, 7.