Abstract
ABSTRACT:It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a significant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more effective.
 OBJECTIVE: To compare the mean time to achieve blood pressure control of oral Nifedipine with intravenous Labetalol for management of severe pregnancy induced hypertension.
 METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group–B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational definition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying t- test and consider significant at p value <5%.RESULTS: Patients were ranged between 20-40 years. Mean age of the patients was calculated as 26.98+4.54 and 27.36+4.43 years in group-A and B respectively. Gestational age shows that 64%(n=32) in Group-A 74%(37%) in Group–B were between 20-30 weeks of gestation while 36%(n=18) in Group-A were between 31-40 weeks of gestation mean±SD was calculated as 28.92+4.91 and 28.94+4.72 weeks in Group-A and B respectively. Mean time to achieve B.P control in group A was 31.24+5.62 and in group B 45.5+4.63 with p value <0.05.
 CONCLUSION: Mean time to achieve blood pressure control was shorter with oral Nifedipine when compared to I/V Labetalol for management of female presenting with severe pregnancy induced hypertension.
Highlights
Severe pregnancy induced hypertension according to guideline is systolic blood pressure >160 mmHg and/or diastolic blood pressure >110 mmHg on two separate occasions 4 hours apart, after 20 weeks of pregnancy[2]
It has been expressed that antihypertensive treatment in pregnancy with labetalol may can possibly hinder fetal conduct in lower degree hypertensive malady of pregnancy when contrasted with Nifedipine
Independent sample t-test shows mean time to achieve BP control in both groups was recorded as 31.24+5.62 minutes in Group-A and 45.5+4.63 minutes in Group-B, it shows significant mean difference between both groups at p value 0.001 (Table -III)
Summary
Severe pregnancy induced hypertension according to guideline is systolic blood pressure >160 mmHg and/or diastolic blood pressure >110 mmHg on two separate occasions 4 hours apart, after 20 weeks of pregnancy[2]. Mostly used drugs suggested from literature including Nifedipine & labetalol hydrochloride Both Nifedipine & labetalol have demonstrated comparable efficacy & a lower risk of overshoot hypotension & fetal distress when compared with hydralazine in randomized controlled trials[6]. Prime attention must balance the possibly inconsistent risks and assistances to mother and fetus[8].Recent guidelines listed hydralazine, Nifedipine and labetalol as first–line alternatives for reducing blood pressure in pregnancy induced hypertension[9]. Oral Nifedipine can be an alternative to intravenous labetalol for lowering blood pressure during hypertensive emergencies in pregnancy. Oral may be preferable because of its ease of oral administration, lower price and a smooth treating schedule Rationale of this is to identify a safe, easy to use and cost effective regimen to control hypertensive crises especially in developing countries like Pakistan. Results of this study may escort the concerned professionals towards a better management of PIH leading to prevention of associated morbidity and mortality
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