A 26 years old primigravida at 30 weeks of gestation on clinical examination, has blood pressure values of 142/100 mm Hg. 150/94 mmHg and 150/100 at 6 hours intervals. The next line of management is:
**Core Concept**
The management of hypertension in pregnancy is critical due to the potential for maternal and fetal complications. Methyldopa is a commonly used antihypertensive agent in pregnancy, particularly in the first and second trimesters, as it has a long history of safe use and is effective in controlling blood pressure.
**Why the Correct Answer is Right**
Methyldopa works centrally by stimulating alpha-2 adrenergic receptors in the brain, which leads to a decrease in sympathetic outflow and a subsequent decrease in peripheral vascular resistance. This action is beneficial in pregnancy, as it does not affect fetal circulation and is not associated with significant fetal side effects. In the given scenario, the patient's hypertension is likely chronic, and methyldopa would be an appropriate choice for initial management due to its safety profile and effectiveness.
**Why Each Wrong Option is Incorrect**
**Option A:** Captopril is an ACE inhibitor, which is contraindicated in pregnancy due to its association with fetal renal damage and other complications.
**Option B:** Atenolol is a beta-blocker, which can cause fetal growth restriction and other adverse effects in pregnancy. It is not typically used as a first-line agent for hypertension in pregnancy.
**Option D:** Ignoring the hypertension at 30 weeks of gestation would be inappropriate, as uncontrolled hypertension can lead to significant maternal and fetal complications, including preeclampsia and fetal growth restriction.
**Clinical Pearl / High-Yield Fact**
Methyldopa is often used in combination with other antihypertensive agents, such as diuretics or nifedipine, to achieve optimal blood pressure control in pregnancy.
**✓ Correct Answer: C. Add methyldopa**