Which IV antihypertensive should be avoided in a pregnant patient with hypertensive emergency?

Nitroprusside should be avoided in pregnant patients with hypertensive emergencies due to its potential toxicity, particularly its ability to release cyanide upon metabolism. In pregnant women, high levels of cyanide can adversely impact both maternal and fetal health. Additionally, nitroprusside can lead to significant hypotension, which may further compromise placental perfusion and oxygen delivery to the fetus.

On the other hand, hydralazine, esmolol, and labetalol are generally considered safer alternatives for managing hypertensive emergencies in pregnancy. Hydralazine is preferred for its ability to selectively dilate blood vessels and lower blood pressure without compromising uteroplacental blood flow. Esmolol is a short-acting beta-blocker that can be administered easily and is beneficial in managing rapid heart rates while controlling blood pressure. Labetalol, which has both alpha and beta-blocking effects, is often the first-line agent for treating severe hypertension in pregnancy due to its favorable profile and efficacy in maintaining maternal blood pressure while ensuring adequate fetal circulation.