Chronic hypertension in pregnancy Quiz: Ace Your Exams

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A 35-year-old woman, gravida 4, para 3, with known chronic hypertension, presents for an initial antenatal visit at 20 weeks of gestation. She has no headaches, vision changes, shortness of breath, right upper quadrant or epigastric pain, contractions, loss of fluid, or vaginal bleeding. Past medical history is notable for 3 spontaneous vaginal deliveries. She was diagnosed with gestational hypertension during her second pregnancy 6 years ago, and her blood pressure did not return to the normal range postpartum. She is taking nifedipine and a prenatal vitamin. Temperature is 36.5°C (97.8°F), pulse is 84/min, respirations are 18/min, and blood pressure is 116/70 mmHg. Physical exam shows appropriate fundal height of 20 cm and weight is within normal limits. Physical exam is unremarkable. Baseline complete blood count (CBC), comprehensive metabolic panel (CMP), urine protein to creatinine (P/C) ratio, and anatomy ultrasound are ordered. Which of the following is the most appropriate management at this time?

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Continue nifedipine, start aspirin (ASA), order electrocardiogram (ECG)

Switch nifedipine to labetalol

Switch nifedipine to labetalol, start ASA, order an ECG

Discontinue nifedipine with follow-up BP check in 1 to 2 weeks

Discontinue nifedipine, start ASA, order an ECG