Abstract Objective: The aim of this study was to compare the effectiveness of two different protocols, labetalol with magnesium sulfate versus hydralazine with magnesium sulfate intravenous infusion with respect to their impact on maternal and fetal hemodynamics in severe preeclampsia. Patients and methods: In this prospective comparative randomized study, a total of 50 pregnant women in severe preeclampsia with gestational age ≥ 32 weeks were randomly recruited into two groups. Group A: 25 patients received labetalol with magnesium sulfate, and group B: 25 patients received hydralazine with magnesium sulfate by intravenous infusion in an escalating manner according to response until the target blood pressure ≤ 145/95 mmHg was achieved. Blood pressure, maternal heart rate, fetal heart rate, and Doppler ultrasound indices of umbilical and middle cerebral arteries were studied before and after treatment. Results: A significant reduction of the maternal blood pressure was achieved in both groups, with significant reduction of maternal heart rate in group A. No significant changes in the umbilical and middle cerebral arteries pulsatility index, resistance index, and systolic/diastolic ratio before and after treatment were noted in both groups. Conclusion: We concluded that both labetalol and hydralazine intravenous infusion regimens are well tolerated and effective in controlling severe hypertension in pregnant women with severe preeclampsia in combination with magnesium sulfate. Both drugs are reassuring as they are not related to any significant changes in fetoplacental circulation. Fetal heart rate did not change significantly after treatment in both groups. Keywords: Preeclampsia, Labetalol, Hydralazine, Doppler indices