Furosemide in postpartum management of severe preeclampsia: A randomized controlled trial.

BACKGROUND: Hypertension in the postpartum period is a common phenomenon and is often a cause for concern. Following delivery, fluid that has been sequestered in the extravascular space is mobilized, producing a large auto-infusion of fluid from the extravascular to the intravascular compartment. As a result of this fluid mobilization process, there is an increase in central venous pressure and pulmonary capillary wedge pressure, which might favor the development of pulmonary edema. Thus, diuretics logically might be a better choice as antihypertensive medication in such a scenario. METHODS: A total of 108 antenatal women diagnosed with having severe preeclampsia, with two high blood pressure recordings of ≥150/100 mm of Hg in the postpartum period within the first 24 hours of delivery, were enrolled in the study. These patients were randomly divided into two groups (Group A: furosemide 20 mg OD + nifedipine & Group B: nifedipine alone). Main outcome measures studied were reduction in systolic, diastolic, and mean arterial blood pressures, requirement of additional antihypertensive drugs to control blood pressure, duration of hospital stay, and antihypertensive requirement at discharge. RESULTS: Both groups were comparable for distribution of age and parity and presence of imminent symptoms and eclampsia. There was no significant difference in mean systolic, diastolic, and mean arterial pressures (MAPs) between both the groups at admission. Mean gestational age at delivery was 36 weeks in both the groups. Requirement of additional antihypertensive was significantly higher in women in group B (26.0% vs. 8.0%, p = 0.017). Duration of hospital and postpartum stay and the use of antihypertensive at discharge were similar in both the groups Conclusion: In conclusion, the use of a short course of furosemide along with nifedipine significantly reduces the need of additional antihypertensive in severe preeclamptic women with postpartum hypertension when compared to women who received nifedipine alone.

Comparison of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour.

The aim of our study was to compare the efficacy and safety of nifedipine and progesterone for maintenance tocolysis after arrested preterm labour, in prolonging pregnancy and preventing recurrence of preterm labour. This study was a randomised comparative study conducted on 110 pregnant women with arrested preterm labour, randomised to receive either nifedipine 20 mg Q 8-hourly or progesterone 400 mg daily for maintenance tocolysis. Other than demographic parameters, obstetric parameters like previous history of abortions or preterm deliveries, gestational age, cervical dilatation and effacement, ultrasound measured cervical length at admission, were noted. Outcome measures studied were mean prolongation of pregnancy, mode of delivery, neonatal outcome and side-effects of both the drugs. We found that there was no significant difference in the demographic profile, parity, number of abortions, previous preterm deliveries, gestational age, cervical dilatation and effacement at admission between the two groups. A total of 10% of the patients in the nifedipine group and 61% of the patients in the progesterone group delivered at term (p value 0.000). The mean prolongation of pregnancy in the nifedipine group was 16.63 days and 40.14 days in the progesterone group which was significant (p = 0.000). Neonates in the progesterone group had better birth weight, better Apgar scores at 1 and 5 min, lesser need for ventilation and significantly lesser composite morbidity. Nifedipine was associated significantly with side-effects. We conclude that when compared with nifedipine, progesterone significantly prolongs pregnancy in women with arrested preterm labour with better neonatal outcomes and fewer side-effects.