Accelerated recovery from severe preeclampsia: uterine curettage versus nifedipine.

Abstract

We investigated the ability of uterine curettage and nifedipine to accelerate postpartum recovery from severe preeclampsia. Forty-five parturients with severe preeclampsia were randomly assigned to one of three groups following delivery. Patients in group 1 were managed with intravenous magnesium sulfate (2 g/hour) and observed in the obstetric recovery room until blood pressure had stabilized (systolic blood pressure less than 150 mmHg and diastolic blood pressure less than 100 mmHg) and adequate diuresis was noted. Group 2 was treated in a similar manner but with the addition of oral nifedipine, 10 mg every 4 hours postpartum for 48 hours. Group 3 underwent an ultrasound-directed curettage immediately following delivery in the delivery/operating room and was then treated as in group 1. All three groups were assessed postpartum for mean arterial pressure (MAP) and urine output (UO) every 2 hours, hematocrit and platelet count every 6 hours, and lactic dehydrogenase/aspartate aminotransferase every 12 hours for 48 hours postpartum. Fifteen women were assigned to each of the three treatment groups. The MAP decreased significantly (P < .0001) in all three groups during the first 48 hours postpartum. Treatment interaction indicated specific differences among the groups. Standard therapy (group 1) was significantly inferior to nifedipine (group 2) and curettage (group 3) in regard to MAP decrease (P = .0017) and UO increase (P = .0137). No statistical differences existed between nifedipine and curettage. The rise in the platelet count following delivery was significantly different among the three groups (P = .033), with a much more rapid recovery in the curettage group (12-18 hours) than in the other groups (P = .0106). Nifedipine and uterine curettage both appear to accelerate recovery from severe preeclampsia, as measured by MAP and UO. Uterine curettage appears the most effective in rapidly resolving the thrombocytopenia associated with severe preeclampsia.