**Question:** Drug of choice in pregnancy induced hypertension is

A. Nifedipine
B. Indomethacin
C. Methyldopa
D. Salbutamol

**Correct Answer:** C. Methyldopa

**Core Concept:**
Pregnancy-induced hypertension (PIH), also known as preeclampsia, is a pregnancy-specific disorder characterized by hypertension and proteinuria after 20 weeks of gestation. It is associated with significant maternal and fetal morbidity and mortality. The goal of treatment is to lower blood pressure, reduce proteinuria, and prevent organ damage.

**Why the Correct Answer is Right:**
Methyldopa (L-alpha-methyldopa) is an alpha-2 adrenergic receptor agonist that works by increasing the production of norepinephrine in the brain, leading to vasoconstriction and lowering blood pressure. Methyldopa is considered the first-line drug for the treatment of PIH due to its efficacy, safety, and minimal risk of fetal exposure.

**Why Each Wrong Option is Incorrect:**

A. Nifedipine (calcium channel blocker) and Indomethacin (nonsteroidal anti-inflammatory drug) are commonly used drugs in the management of PIH. However, they have the following limitations:

- Nifedipine: Crosses the placenta, leading to neonatal hypotension and bradycardia due to fetal exposure.
- Indomethacin: Crosses the placenta, causing premature closure of the ductus arteriosus and potentially leading to respiratory distress syndrome in the neonate.

B. Salbutamol (beta-2 adrenergic receptor agonist) is primarily used in asthma management, not hypertension. It doesn't address the underlying mechanism of PIH and may be harmful in pregnancy due to fetal stimulation.

**Clinical Pearl:**
Methyldopa is a safe and effective choice for the management of PIH as it does not cross the placenta and has a low risk of fetal exposure. This makes it a preferred option over nifedipine and indomethacin, which can cause adverse effects in the newborn.