ABSTRACT
Background: To compare intravenous labetalol with oral nifedipine in terms of rapidity at which they control blood pressure in acute hypertensive emergencies of pregnancy.Methods: A randomized controlled study. Pregnant women with severe gestational hypertension with BP ≥160/110 mmHg after ≥20 weeks of gestation were randomized with computer generated numbers, either to receive IV labetalol with an escalating dose of 20, 40, 80, 80 and 80 mg or nifedipine capsule orally in a dose of 10 mg every 15 minutes (upto 5 doses) until a BP of ≤150/100 mmHg is achieved. Crossover treatment was to be effected if initial treatment regimen was unsuccessful. Primary outcome was time taken and number of doses required to achieve the target BP of ≤150/100 mmHg. Secondary outcomes were volume of urine output, maternal heart rate changes, fetal heart rate abnormality, perinatal and maternal outcome and side effects.Results: Oral nifedipine achieved the target BP (≤150/100 mmHg) more rapidly in (26.25±12.60) minutes in comparison to (32.62±12.19) minutes with IV labetalol (p= 0.024). Nifedipine group also took less number of doses to achieve the target BP of (≤150/100 mmHg) mmHg than IV labetalol (1.75±0.840 vs. 2.18±0.83), p= 0.024. Volume of urine output was also significantly more in nifedipine group (94.90±1.84 ml) at 1 hour and thereafter till 24 hour of treatment in comparison to IV labetalol (41.28±2.14 ml), p= 0.000. Side effects are few and not serious. No patient required crossover treatment.Conclusions: Both the drugs are equally effective in controlling acute hypertensive emergencies of pregnancy, however oral nifedipine is more rapid in controlling severe hypertension and also it is associated with significantly increased urine output.
ABSTRACT
Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.