What is an essential first step in managing severe hypertension during pregnancy?

Initiating IV antihypertensive therapy is a crucial first step in managing severe hypertension during pregnancy because it allows for rapid and effective control of blood pressure. Severe hypertension is defined as a systolic blood pressure of 160 mmHg or higher or diastolic blood pressure of 110 mmHg or higher. Such elevated levels pose significant risks to both the mother and fetus, including the potential for complications like stroke, placental abruption, and fetal distress.

The use of intravenous medications enables clinicians to achieve swift blood pressure reduction, which is vital in preventing these complications. Medications such as labetalol, hydralazine, or nicardipine can provide immediate effects, ensuring the patient's safety and stabilizing her condition. This approach is especially important because oral medications may take longer to act and cannot offer the same rapid control as intravenous options.

Additionally, while monitoring for 24 hours is necessary and plays a role in ongoing assessment, it cannot replace the urgency of treating severe hypertension immediately. Immediate cesarean delivery is not routinely required unless there are other indications, such as severe maternal or fetal distress. Oral medication adjustments may be appropriate for less severe hypertension but are not suitable for acute management of severe cases. Therefore, commencing IV antihypert