Introduction
bleeding, Preeclampsia, infection, cerebral bleeding, hypertensive, hypertension, preeclampsia
BLEEDING, HIGH BLOOD PRESSURE, SEVERE PREECLAMPSIA, PREECLAMPSIA, INFECTION, PREECLAMPSIA AND ECLAMPSIA, HYPERTENSION, PREECLAMPSIA
Preeclampsia and eclampsia are major problems in obstetric cares. Preeclampsia is one of the main causes of maternal morbidity and mortality in addition to infection and bleeding with the prevalence rate between 5–8% among pregnant women.
High blood pressure is the main indicator in the diagnosis of preeclampsia. Treatment of severe preeclampsia requires anticonvulsant and antihypertensive drugs. The purpose of administering antihypertensive drugs is to prevent cerebral bleeding. The American Congress of Obstetricians and Gynaecologists (ACOG) states that pregnant women with systolic blood pressure 160 mmHg and/or diastolic 110 mmHg that persist for 15 minutes should be considered an emergency condition and receive antihypertensives immediately, no later than 30 minutes.
An indicator of a decrease in blood pressure in patients with severe preeclampsia is the mean arterial pressure (MAP). MAP is obtained by the formula of twice the diastolic pressure plus one systolic pressure, then divided by three.
Recommendations for antihypertensive drugs in preeclampsia are changing rapidly. Multiple antihypertensive drugs have been listed as drugs of choice for the treatment of severe preeclampsia but then excluded due to inconsistent treatment outcomes. Intravenous labetalol and intravenous hydralazine have long been considered as first-line therapy in hypertensive emergencies, severe hypertension in pregnant women, and in the postpartum period.
Previous studies on the effectiveness of these three drugs showed mixed results.
In our preliminary study, the emergency antihypertensive drugs in severe preeclampsia that are often used in the Arifin Achmad Hospital, Riau Province of Indonesia and the affiliated hospitals of Faculty of Medicine, Universitas Riau, are nifedipine and methyldopa. There has never been a standardized study or observation on the safety and effectiveness of antihypertensive drugs in Indonesian population. Therefore, this study was conducted to compare the effectiveness of oral nifedipine, and intravenous labetalol and intravenous hydralazine as antihypertensives in severe preeclampsia.