Abstract
BackgroundHypertension affects about 10 % of pregnancies and is responsible for both maternal and neonatal devastating complications such as eclampsia, HELLP syndrome, prematurity and maternal and neonatal death. The resolution of the disease occurs in the first twelve weeks postpartum. The behavior of blood pressure and occurrence of very high blood pressure episodes among women with severe preeclampsia is related to remodeling of the dynamics of body fluids with consequent increase in intravascular volume. The persistence of hypertension in critical levels results in increased puerperal morbidity.ObjectivesTo evaluate the effectiveness of furosemide in accelerating blood pressure recovery among women with severe preeclampsia.Methods/designA triple-masked placebo controlled clinical trial, will be conducted including 120 postpartum women with severe preeclampsia, after eclampsia prophylaxis with magnesium sulfate and with adequate diuresis. Women with chronic hypertension and users of diuretics will be deleted. Informed consent will be obtained from all participants. Patients will be randomized to receive furosemide (40 mg orally every twenty four hours) or placebo. The variables are systolic and diastolic blood pressure, frequency of hypertensive crises, need for maintenance of antihypertensive therapy, number of antihypertensive agents used to control blood pressure, urine output, length of hospital stay, adverse effects and maternal complications. This study was approved by the Research Ethics Committee in humans of our institution. All participants will be duly informed about the aims of the project and will be included only if they agree to participate voluntarily, signing the informed consent.Trial registrationThis study was registered on Clinical Trials.gov under the number NCT02163655. (http://clinicaltrials.gov/show/NCT02163655).
Highlights
Hypertension in pregnancy continues to represent a real public health issue
The overall objective is to determine the effectiveness of furosemide to accelerate the recovery of hypertension in postpartum patients with severe preeclampsia in a randomized clinical trial
Specific objectives In patients with severe preeclampsia receiving furosemide or placebo in postpartum, compare: the need for maintenance of antihypertensive therapy for blood pressure control; Fewer antihypertensive agents are needed in order to control blood pressure at hospital discharge; Time until blood pressure control is lower; Daily urine output is higher; Reduction of edema is obtained in less time; Length of hospital stay is reduced
Summary
Hypertension in pregnancy continues to represent a real public health issue. Among hypertensive disorders complicating pregnancy, pre-eclampsia and eclampsia represent the most severe conditions [7, 8]. Cursino et al Reproductive Health (2015) 12:66 and are represented by fetal growth restriction, hypoxia and fetal death, prematurity and its complications, among which the most important is the respiratory distress syndrome of the newborn [9]. Magnesium sulfate significantly reduces maternal death when used to treat eclampsia and is a real "evidence-based solution" http://www.engenderhealth. Hypertension affects about 10 % of pregnancies and is responsible for both maternal and neonatal devastating complications such as eclampsia, HELLP syndrome, prematurity and maternal and neonatal death. The persistence of hypertension in critical levels results in increased puerperal morbidity
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