Drug treatment in preeclampsia and eclampsia

Autor: T. W. Goecke, W. Klockenbusch
Rok vydání: 1999
Předmět:
Zdroj: Der Gynäkologe. 32:776-782
ISSN: 1433-0393
0017-5994
DOI: 10.1007/pl00003183
Popis: There is little to suggest that the course of preeclamsia can be substantially affected by drug treatment. The vast majority of randomized studies do not indicate beneficial effects of antihypertensive treatment on proteinuria, fetal heart rate abnormalities, abruptio placentae and the incidence of preterm birth. There is also no definite effect on the development of superimposed preeclampsia, HELLP syndrome, renal failure or eclampsia. Moreover, blood pressure lowering agents fail to improve uteroplacental perfusion but may have adverse effects on fetal growth. Antihypertensive treatment is only indicated in severe hypertension ( > 170/110 mm Hg) to reduce the risk of cerebral hemorrhage. Dihydralazine injections may result in reduced placental blood flow and fetal distress. Oral nifedipine offers some advantages in view of more potent vasodilator actions on uterine and fetoplacental vessels and a lower incidence of fetal distress. Increasing evidence suggests that the mechanism of eclamptic seizure is cerebral vasoconstriction with resultant ischemia. Cerebral vessels are particularly sensitive to magnesium, which works by reversing cerebral vasoconstriction with resultant improvement in blood flow. Controlled trials have shown magnesium to be superior to both placebo and phenytoin for the prevention of eclampsia. Furthermore, magnesium has been found to be more effective than diazepam and phenytoin in preventing recurrence of seizures in women with eclampsia. Also the neonatal outcome favors magnesium, which is now generally accepted as the drug of choice for the prevention and treatment of eclampsia.
Databáze: OpenAIRE
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