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Re: Gestational Hypertension follow upFrom: vnellsch (vnellsch@eastex.net)Sun Sep 28 11:56:41 2008
how about procardia (nifedipine), good for premature labor as well. vnellsch
> ----- Original Message ----- It was Redman et al who first studied Aldomet (Methyldopa) properly in the 70s (Br J Obstet Gynaecol 84 :419-426) and he showed a reduction in superadded pre-eclampsia and eclampsia. Others have not been so sure. Make of the following what you will: Here is part of a review in Cardiovascular Drug Reviews Volume 26, Issue 1, Pages 38-49 Published Online: 28 Jun 2008 by Firas A Ghanem & Assad Movahed: Section of Cardiology, Department of Medicine, The Brody School of Medicine East Carolina University, Greenville, North Carolina, USA Methyldopa (B) Methyldopa is the most studied among currently used antihypertensive drugs. It has the longest safety record and is considered by most clinicians to be the drug of choice in the treatment of hypertension in pregnancy (Sibai 1996). Treatment with methyldopa in the last trimester in women with pregnancy-induced hypertension reduced maternal blood pressure and heart rate but had no adverse effects on uteroplacental and fetal hemodynamics (Montan et al.1993). Although a decrease in neonatal head circumference has been reported after first-trimester exposure to methyldopa (Moar et al. 1978), a follow-up study to the age of 4 years showed less developmental delay in those infants whose mothers were treated with methyldopa during pregnancy than those whose mothers were untreated (Ounsted et al. 1980). Published reports demonstrated neither short-term effects on the fetus or neonate nor long-term effects during infancy after the long-term use of methyldopa in pregnancy (Sibai 1996) although there are no sufficient data on its use in the first trimester of pregnancy. Additionally, methyldopa is a weak antihypertensive drug that needs to be given three or four times a day and frequently requires titration leading to potential maternal adverse effects, use of an additional medication or nonadherence to therapy (Redman et al.1977). And Labetalol (C) Labetalol, a combined á1- and â-adrenoceptor antagonist with vasodilatory effects, can decrease blood pressure in pregnancy without compromising uteroplacental blood flow (Lunell et al. 1982). In a placebo-controlled study treatment in mild-to-moderate gestational hypertension, labetalol demonstrated its efficacy without any increase in IUGR or neonatal hypoglycaemia with a trend toward reduction in preterm delivery, neonatal respiratory distress syndrome, and jaundice in the labetalol-treated group (Pickles et al. 1989). Plouin et al. (1988) compared labetalol with methyldopa in a randomized controlled trial involving 176 pregnant women with mild-to-moderate hypertension. Blood pressure reduction, average birth weight, heart rate, blood glucose, and respiratory rate were similar in both groups. In a more recent trial comparing the two drugs, labetalol achieved faster and more efficient blood pressure control, having a beneficial effect on renal functions and was better tolerated than methyldopa (el-Qarmalawi et al. 1995). The use of labetalol versus hydralazine did not show any difference in the outcome of birth weight nor clinical signs of adrenergic blockade at 24 h of age (Hjertberg et al. 1993). Steve Raymond Ph (03)62227898 Cell 0438372395 -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain Ramirez Sent: Sunday, 28 September 2008 3:28 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Gestational Hypertension follow up Control her hypertension with antihypertensives.. Ef
>At Fri, 26 Sep 2008, Andrew Folley wrote:
>
>Thanks for the quick input. Mom is 35 years of agf BF. BP has been 145/95 (not 85 typo).
>I am going to stick with guidelines and your suggestions and not treat the BP unless over 150/100 (or MAP > 125?) andy
>
>Date: Fri, 26 Sep 2008 09:51:39 -0500From: DoctorJoe@aol.comTo: ob-gyn-l@mail.obgyn.netSubject: Re: Gestational HypertensionIn a message dated 9/26/08 9:06:45 AM, agfolley@hotmail.com writes:
>G1P0 at 28 weeks. Developed rise in BP form 110/60 during first trimeester up to 145/85 persistently over past 4 weeks. No proteinuria, symptoms, no oligo and normal growth and normal labs. QUESTION: Treat with antihypertensive on not treat????? I say observe and monitor but no treatment. Colleagues say start labetalol. As far as I know antihypertensives will not prevent development of toxemia or developent of IUGR (less certain about the latter?) How OLD is the mother? Joe P CONFIDENTIALITY NOTICE AND DISCLAIMER The information in this transmission may be confidential and/or protected by legal professional privilege, and is intended only for the person or persons to whom it is addressed. If you are not such a person, you are warned that any disclosure, copying or dissemination of the information is unauthorised. If you have received the transmission in error, please immediately contact this office by telephone, fax or email, to inform us of the error and to enable arrangements to be made for the destruction of the transmission, or its return at our cost. No liability is accepted for any unauthorised use of the information contained in this transmission. If the transmission contains advice, the advice is based on instructions in relation to, and is provided to the addressee in connection with, the matter mentioned above. Responsibility is not accepted for reliance upon it by any other person or for any other purpose.
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