Pre-eclampsia Management of hypertension in pregnancy raises a

Pre-eclampsia is
part of a range of conditions known as the hypertensive disorders of pregnancy
that is characterised by the new onset new onset of raised blood pressure and proteinuria
after 20 weeks of gestation.4 Signs and symptoms of pre-eclampsia
include the following2:

 

·        
Headaches

·        
Tinnitus

·        
Visual
disorders

·        
Brisk
tendon reflexes

·        
Uterine
contraction

·        
Dyspnoea

·        
Vaginal
bleeding

·        
Oedema

·        
Proteinuria

 

In the above
case, the patient demonstrated the key symptoms of pre-eclampsia like hypertension,
proteinuria, oedema, and increased reflexes.

 

Management
of hypertension in pregnancy raises a series of challenges to the health care
team. In order to choose the most favourable treatment option for the mother
and the foetus a deep understanding of the adaptive physiological, psychological
and social processes is necessary.4

 

Antihypertensive
drug therapy is advised for pre-eclampsia in women with systolic BP of ?160 or
diastolic BP ?110 mmHg. Antihypertensive drugs like methyldopa and labetalol
are first-line antihypertensive drugs used for pre-eclampsia. Methyldopa due to
its common drug side effects of depression was not used in the above case, as
the patient had a history of depression. 
Since the patient was asthmatic labetalol was also contraindicated in
the patient and hence was not used.4

 

The
patient was given nifedipine, a type 2 calcium channel blocker which is usually
used as a second-line agent in cases where blood pressure is noncompliant to
treatment with methyldopa and beta blockers. The primary effect of nifedipine is
to cause smooth muscles relaxation and it acts by inhibiting the inward
transfer of calcium ions from extracellular space.4

 

In woman developing
pre-eclampsia, calcium intake is a potential intervention to reduce its risk.
Calcium is relatively cheap and readily available and is likely to be safe for
the woman and her child.3 Calcium dihydroxy-2,5 benzenesulfonate or
calcium dobesilate has been widely used as an angioprotective agent for the
treatment of vascular disease. It has been reported to act effectively in
inhibiting platelet aggregation, thrombus formation, increased capillary
permeability, capillary fragility, increased blood viscosity and other haemorheological
disturbances.5

Tamás P et al., evaluated the effect of calcium
dobesilate in pregnancies complicated with pregnancy-induced hypertension or
mild/moderate pre-eclampsia in a double-blind, placebo-controlled pilot study. Primigravida
patients (gestational age ?34 weeks) daily took 2 g calcium dobesilate (n = 11)
or placebo (n = 12) until delivery. The study reported a decrease in mean
arterial 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 group
compared to placebo group. Thus, according to the above study, calcium
dobesilate seem to favourably influence the blood pressure and consequently
decrease the requirement for medication and hospitalisation in cases of
mild-to-moderate mid-trimester hypertension.6   

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