DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190858

A randomized cross over trial of oral nifedipine and intravenous labetalol in pregnant women with severe pre-eclampsia and eclampsia

Kirtan Krishna, N. Shailaja, B. Shyamasundara Bhat, L. Krishna, Namrata .

Abstract


Background: The aim of treatment of severe pre-eclampsia and eclampsia is to quickly bring about a smooth reduction in blood pressure to levels that are safe for both mother and baby but avoiding any sudden drops. There are not many studies comparing nifedipine and labetalol for this purpose. Authors conducted this study with the aim of comparing their efficacy in reducing maternal blood pressure.

Methods: It was a cross over trial with 30 patients in each group conducted at a tertiary care hospital. 60 pregnant women were randomized to receive nifedipine (20mg loading dose followed by 10 mg tablet, orally, up to maximum of five doses) or  intravenous labetalol  (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg)  every 20 minutes until the target blood pressure of 150/100 mmHg was achieved. Crossover treatment was affected if the initial treatment regimen was unsuccessful after 20 min of the last dose of the drug in the respective groups.

Results: The mean time to achieve the target blood pressure was 32.0 ±18.64 minutes (mean ± SD) in nifedipine group as compared with 37.04 ± 16.36 minutes in those receiving labetalol (P = .002). In the nifedipine group 63.3% required only one dose compared to 36.6% in the labetalol group.  Only two women in the nifedipine group required maximum number of doses that is five doses. Cross over treatment was required by 10% of patients in the labetalol group and none in the nifedipine group.

Conclusions: This study shows that oral nifedipine is more effective than intravenous labetalol in rapid control of hypertension in severe pre-eclampsia and eclampsia.


Keywords


Eclampsia, Hypertension, Labetalol, Nifedipine, Pre-eclampsia

Full Text:

PDF

References


Witlin AG, Sibai BM. Magnesium sulphate therapy in preeclampsia and eclampsia. Obstet Gynecol. 1998;92(5):883-9.

Sahin G, Gulmezoglu AM. Incidence morbidity and mortality of pre-eclampsia and eclampsia. Geneva Foundation for Medical Education and Research 2003.

Rey E, LeLorier J, Burgess E, Lange IR, Leduc L. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ 1997:157(9):1245-54.

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183(1):S1-22.

Brown MA, Hague WM, Higgins J, Lowe S, McCowan L, Oats J, et al. The detection, investigation and management of hypertension in pregnancy: executive summary. Aust NZJ Obstet Gynaecol. 2000;40(2):133-8.

Duley L, Henderson‐Smart DJ, Meher S. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database of Systematic Reviews. 2006(3).

Cutler JA. Calcium-channel blockers for hypertension—uncertainty continues. N Eng J Med 1998;338:679-81

Ben Ami M, Giladi Y, Shalev E. The combination of magnesium sulphate and nifedipine: a cause of neuromuscular blockade. Br J Obstet Gynaecol 1994;101(3):262-3.

Snyder SW, Cardwell MS. Neuromuscular blockade with magnesium- sulfate and nifedipine. Am J Obstet Gynecol. 1989;161(1):35-6.

Stevens TP, Guillet R. Use of glucagon to treat neonatal low-output congestive heart failure after maternal labetalol therapy. J Pediatr 1995;127(1):151-3.

Mackay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001;97(4):533–8.

Waugh J, Bell SC, Kilby M, Seed P, Blackwell C, Shennan AH, et al. Optimal bedside urinalysis for the detection of proteinuria in hypertensive proteinuria: a study of diagnostic accuracy? BJOG2005:112(4):412-17.

Waugh JJ, Clark TJ, Divakaran TG, Khan KS, Kilby MD. Accuracy of urinalysis dipstick techniques in predicting significant proteinuria in pregnancy. Obstet Gynecol. 2004;103(4):769-77.

Phelan LK, Brown MA, Davis GK, Mangos G.A prospective study of the impact of automated dipstick urinalysis on the diagnosis of pre-eclampsia. Hypertens Pregnancy 2004;23(2):135-42.

Martin JN Jr, May WL, Magann EF, Terrone DA, Rinehart BK, Blake PG. Early risk assessment of severe pre-eclampsia: admission battery of symptoms and laboratory tests to predict likelihood of subsequent significant maternal morbidity. Am J Obstet Gynecol 1999;180(6):1407-14.

Vermillion ST, Scardo JA, Newman RB, Chauhan SP. A randomized, double-blind trial of oral nifedipine and intravenous labetalol in hypertensive emergencies of pregnancy. AJOG.1999;181(4):862-6.

Raheem IA, Saaid R, Omar SZ, Tan PC. Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy: a randomised trial. BJOG: Int J Obstet Gynaecol. 2012;119(1):78-85.

Sibai BM: Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003;102(1):181.

National Institute of Health and Clinical Excellence. Hypertension in Pregnancy, The management of hypertensive disorders during pregnancy. Clinical guidelines CG107 Issued: August 2010. Available at http://guidance.nice.org.uk/CG107. Last accessed 26 December 2010.

The Royal College of Obstetricians and Gynaecologists, United Kingdom. Green Top Guideline No. 10 (A). The management of severe pre-eclampsia/eclampsia. March 2006. Available at online www.rcog.org.uk/files/rcog-corp/upload files/GT10a Management Preeclampsia 2006.pdf. .

Scardo JA, Hogg BB, Newman RB. Favorable hemodynamic effects of magnesium sulphate in preeclampsia. Am J Obstet Gynecol 1995;173(4):1249-53.

Waisman GD, Mayorga LM, Camera MI, Vignolo CA, Martinotti A. Magnesium plus nifedipine: potentiation of hypotensive effect in preeclampsia? Am J Obstet Gynecol. 1988;159(2):308-9.

Ben-Ami M, Giladi Y, Shalev E. The combination of magnesium sulphate and nifedipine: a cause of neuromuscular blockade. Br J Obstet Gynaecol1994;101(3):262-3.

Snyder SW, Cardwell MS. Neuromuscular blockade with magnesium sulphate and nifedipine. Am J Obstet Gynecol1989;161(1):35-6.