Intravenous labetalol versus oral nifedipine in the treatment of severe hypertension in pregnancy

To evaluate the efficacy of intravenous labetalol versus oral nifedipine in the treatment of severe hypertension with pregnancy. Prospective, non-randomized. Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. Fifty pregnant patients with severe hypertension [blood pressure >/= 160/110 mmHg]. The patients were consecutively given either intravenous labetalol or oral nifedipine. The speed and adequacy of control of blood pressure was compared in both groups Both drugs were effective in the control of blood pressure, but nifedipine caused significant reduction of blood pressure in 20 minutes with a single dose i.e., with the first dose [p = 0.03]. The diastolic blood pressure reduction was also significant with nifedipine [15.1 +/- 6 Vs 8.3 +/- 2 mmHg] [p = 0.03]. Average time required was also less with nifedipine [24 +/- 8.2 Vs 44.21 +/- 26.31 minutes, p = 0.006]. Both drugs effectively controlled the blood pressure in severe hypertension in pregnancy. However, nifedipine faired better than labetalol in time taken, reduction of diastolic blood pressure and number of patients responding with first dose [i.e., in 20 minutes]

Prediction of mortality and morbidity by simplified acute physiology score II in obstetric intensive care unit admissions.

BACKGROUND: Critical care in obstetrics has received much attention in recent times. Despite progress in medical field and improvement in health facilities provided, maternal mortality is still very high in most of the developing countries. AIM: To study and analyze records of patients requiring intensive care in obstetrics and to assess utility of simplified acute physiology score (SAPS II) for predicting maternal mortality. SETTING: A multidisciplinary intensive care unit (ICU) at a tertiary care center. DESIGN: Retrospective review. MATERIALS AND METHODS: Fifty-seven consecutive obstetric patients' records requiring ICU admissions were studied for clinical picture, diagnosis, complications, morbidity and mortality over a period of 21/2 years - from 1st May 2002 to 31st Oct. 2004. SAPS II score was calculated according to the different variables for predicting mortality. STATISTICAL ANALYSIS: SAPS II scores were regressed on mortality status using logistic regression analysis. The predictability was assessed by goodness-of-fit test and receiver operated characteristic curve. RESULTS: Maternal mortality in obstetric ICU admissions was 1.15/1,000 deliveries, amounting to 40.35% of obstetric ICU admissions. The mean SAP II score was significantly higher (40.04 +/- 12.97 vs. 22.6 +/- 7.31) in those patients who died compared to survivors (P < 0.001%). CONCLUSIONS: The SAPS II accurately predicted mortality in obstetric patients admitted to ICU. Computation of the score as a routine in ICU may help in identifying those at high risk of mortality and then to reduce this risk.