COMPARATIVE STUDY BETWEEN ORAL NIFEDIPINE AND INTRAVENOUS LABETALOL IN MANAGEMENT OF SEVERE PREGNANCY INDUCED HYPERTENSION

Prof. S. Randhoni Devi, Dr. R. K. Praneswori Devi, Dr. L. Ajit Kumar, Dr. Romita Devi, Dr. Sujit Das*,
Dr. Deepthambika and Dr. Abhipsa

ABSTRACT

Objective: To evaluate efficacies of oral nifedipine and intravenous labetalol in the management of severe pregnancy induced hypertension and analyse fetomaternal outcome. Methods: In this nonrandomised controlled study one hundred cases having severe pregnancy induced hypertension divided into two groups. Each group had 50 cases; nifedipine group and labetalol group. Patients in nifedipine group was given 10 mg initially, with repeated doses of 10 mg, every 15 minutes, for up to a maximum of 5 doses, or until the goal blood pressure less than or equal to 150/100 mm Hg was attained. Patients in intravenous labetalol group, was given 20 mg initially followed by escalating doses of 40 mg, 80mg, and then 80 mg, every 15 minutes, until the therapeutic goal blood pressure was achieved, or for a maximum of five doses. Corresponding placebos either 0.9% isotonic saline solution or inactive tablet was given simultaneously in each regimen. If therapeutic blood pressure was not achieved over 5 doses then cross over treatment was given. Results: The results of the study showed that the mean time required to achieve target blood pressure is 71.00±66.60 minutes in labetalol group and 25.20±14.03 minutes in the nifedipine group with the p value of < 0.01. The nifedipine group required in average 1.12±.32 doses to bring about the desired action and the labetalol group required 2.04±1.37 doses to bring about the same action which is statistically very highly significant (‘P’ value <0.01). Urine output at 60 minutes of commencing treatment is 55.20±16.72 ml in labetalol group compared to 99.10 ± 27.15 ml in nifedipine group with a ‘P’ value <.001. urine output at 60 minutes of commencing treatment is 55.20±16.72 ml in labetalol group compared to 99.10 ± 27.15 ml in nifedipine group with a ‘P’ value <.001. 10% failure rate is noted only in labetalol group requiring cross over treatment (P = 0.22). Fetomaternal outcome was more or less similar in both the group. Only one case of maternal mortality was seen in labetalol group as a result of eclampsia related complications. Conclusion: Both oral nifedipine and intravenous labetalol are effective in the management of severe pregnancy induced hypertension; however oral nifedipine controls hypertension more rapidly and with fewer doses and is associated with a significant increase in urinary output.

Keywords: Oral Nifedipine and Intravenous Labetalol.