Pre-eclampsia Management of hypertension in pregnancy raises a

Topic: HealthDisease
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Last updated: June 11, 2019

Pre-eclampsia ispart of a range of conditions known as the hypertensive disorders of pregnancythat is characterised by the new onset new onset of raised blood pressure and proteinuriaafter 20 weeks of gestation.4 Signs and symptoms of pre-eclampsiainclude the following2:  ·        Headaches·        Tinnitus·        Visualdisorders·        Brisktendon reflexes·        Uterinecontraction·        Dyspnoea·        Vaginalbleeding·        Oedema·        Proteinuria In the abovecase, the patient demonstrated the key symptoms of pre-eclampsia like hypertension,proteinuria, oedema, and increased reflexes. Managementof hypertension in pregnancy raises a series of challenges to the health careteam. In order to choose the most favourable treatment option for the motherand the foetus a deep understanding of the adaptive physiological, psychologicaland social processes is necessary.4 Antihypertensivedrug therapy is advised for pre-eclampsia in women with systolic BP of ?160 ordiastolic BP ?110 mmHg.

Antihypertensive drugs like methyldopa and labetalolare first-line antihypertensive drugs used for pre-eclampsia. Methyldopa due toits common drug side effects of depression was not used in the above case, asthe patient had a history of depression. Since the patient was asthmatic labetalol was also contraindicated inthe patient and hence was not used.

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4 Thepatient was given nifedipine, a type 2 calcium channel blocker which is usuallyused as a second-line agent in cases where blood pressure is noncompliant totreatment with methyldopa and beta blockers. The primary effect of nifedipine isto cause smooth muscles relaxation and it acts by inhibiting the inwardtransfer of calcium ions from extracellular space.4  In woman developingpre-eclampsia, calcium intake is a potential intervention to reduce its risk.Calcium is relatively cheap and readily available and is likely to be safe forthe woman and her child.

3 Calcium dihydroxy-2,5 benzenesulfonate orcalcium dobesilate has been widely used as an angioprotective agent for thetreatment of vascular disease. It has been reported to act effectively ininhibiting platelet aggregation, thrombus formation, increased capillarypermeability, capillary fragility, increased blood viscosity and other haemorheologicaldisturbances.5 Tamás P et al., evaluated the effect of calciumdobesilate in pregnancies complicated with pregnancy-induced hypertension ormild/moderate pre-eclampsia in a double-blind, placebo-controlled pilot study.

Primigravidapatients (gestational age ?34 weeks) daily took 2 g calcium dobesilate (n = 11)or placebo (n = 12) until delivery. The study reported a decrease in meanarterial pressure in calcium dobesilate group (Figure 1),while placebo group reported slight increase. Changes of platelet count, plasma and blood viscosity,and erythrocyte deformability were favourable in the calcium dobesilate groupcompared to placebo group.

Thus, according to the above study, calciumdobesilate seem to favourably influence the blood pressure and consequentlydecrease the requirement for medication and hospitalisation in cases ofmild-to-moderate mid-trimester hypertension.6   

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