Study design and population
atrial fibrillation, allergy, preeclampsia, proteinuria
HEART DISEASE, PULMONARY DISORDERS, ALLERGY, SEVERE PREECLAMPSIA, PREECLAMPSIA, PULMONARY EDEMA, MILD PREECLAMPSIA, ATRIAL FIBRILLATION, PREECLAMPSIA
This prospective randomized comparative clinical study was conducted in the surgical intensive care unit; Zagazig University Hospitals between October 2020 to February 2022 on singleton pregnant women who suffered from late-onset preeclampsia with severe features and aged 21–45 years old with a body mass index ≤ of 35 kg/mParturients who were diagnosed to have mild preeclampsia and those with a history of preexisting heart disease, atrial fibrillation or any rhythm abnormality, pulmonary disorders, allergy, or contraindications to either magnesium sulfate or labetalol and exposure to any of these study medications within 24 hours before the study enrollment as well as those with inadequate temporal window were excluded from this study.Before study enrollment, all parturients were subjected to history taking, clinical examination, and investigated by complete blood picture, coagulation profile, liver functions test, and kidney functions test with the full examination by an obstetrician not involved in this study to diagnose those with severe preeclampsia who were immediately admitted and managed in the surgical intensive care unit. On physical examination, special attention was given to document vital signs (heart rate, systolic and diastolic invasive blood pressure); cardiac and chest condition and exclude contraindications to the study medications. The goal and endpoints of the study were discussed, to clarify the advantages and possible side effects of the study medications.Preeclampsia was diagnosed according to the American College of Obstetricians and Gynecologists (ACOG) criteria defining preeclampsia as persistent elevation of systolic blood pressure (SBP) > 140mmHg and/or diastolic blood pressure (DBP) > 90mmHg after 20 weeks of gestation with significant proteinuria and preeclampsia with severe features was diagnosed depending on the presence of one or more of the following: Systolic blood pressure elevation ≥ 160mmHg or diastolic blood pressure ≥ 110mmHg measured on two occasions at least 4 hours apart, presence of pulmonary edema, decrease in the platelet count less than 100,000Following ICU admission and preeclampsia severity features confirmation, all parturients fulfilling the inclusion criteria were subjected to baseline TCD evaluation and then randomly allocated into 2 equal groups to receive one of the study medications.Randomization was performed by sealed opaque envelopes containing random numbers generated by an online application (