Abstract
Objective:To compare oral Nifidepine and IV labetalol in terms of rapidity of BP control in severe preeclampsia.Methods:All patients coming to Services Hospital from March 2017 to February 2019 with diagnosis of severe preeclampsia ≥ 24 weeks gestation were randomized to either receive Nifidepine or Labetalol. Primary outcome measure was time taken to control BP and number of doses required. Secondary outcome measures were side effects of drugs, APGAR score, NICU admission and perinatal mortality.Results:Two hundred four patients were included in trial with 102 patients in each group. Labetalol took 22.6± 13.5minutes and Nifidepine took 22.09± 11.7 minutes to achieve target BP (p>0.05). Labetalol required 2.3± 1.58 doses and Nifidepine 2.2± 1.58 doses to control BP ( p>0.05). No maternal side effects were seen in 86 (84.31%) and 92(90.19%) patients in both groups (p>0.05). Mean gestational age at birth was 34.8 ±2.73weeks in Labetalol and 35.2±2.48 weeks in Nifidepine group (p>0.05). In labetalol group, 43 (42.15%) babies had APGAR Score < 7/10 and 23(22.54%) babies required admission to NICU while in Nifidepine group 42 (41.17%) babies had Apgar score < 7/10 & 30(29.4%) babies were admitted to NICU(p>0.05). There were 21(20.5%) perinatal deaths in labetalol Group-And 19(18.6%) in Nifidepine group (p>0.05)Conclusion:Oral Nifidepine and IV labetalol are equally efficacious in controlling BP in patients with severe pre eclampsia without any significant side effects.
Highlights
Hypertensive disorders of pregnancy complicate 4-7% of pregnancies and the second leading cause of maternal death worldwide[1]
Severe preeclampsia is defined as systolic blood pressure (BP) of ≥160mmhg and diastolic BP of ≥ 110mmHg along with proteinuria of ≥ 300mg/24 hours
Eclampsia and placental abruption was seen in 4(3.92%) patients each in Labetalol Group-A and 03 patients developed eclampsia and 7(6.86%) patients had placental abruption in Group-B
Summary
Hypertensive disorders of pregnancy complicate 4-7% of pregnancies and the second leading cause of maternal death worldwide[1]. The disease varies in spectrum from mild hypertension to preeclampsia and eclampsia. Severe preeclampsia is defined as systolic blood pressure (BP) of ≥160mmhg and diastolic BP of ≥ 110mmHg along with proteinuria of ≥ 300mg/24 hours. Clinical symptoms and signs of headache, visual disturbances, epigastric pain, abnormal liver and renal function tests and thrombocytopenia may be present. If not treated, it results in pulmonary edema, cerebral hemorrhage, liver and renal failure and . Pak J Med Sci September - October 2020 Vol 36 No 6 www.pjms.org.pk 1147 maternal death. As a result of placental hypo perfusion, fetal growth restriction and death may occur as well.[2]
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