Accelerated Recovery From Severe Preeclampsia

Abstract

OBJECTIVE: We investigated the ability of uterine curettage and nifedipine to accelerate post partum recovery from severe preeclampsia.

METHODS: Forty-five parturients with severe preeclampsia were randomly assigned to one of three groups following delivery. Patients in group 1 were managed with intravenous magnesium sulfate (2 g/hour) and observed in the obstetric recovery room until blood pressure had stabilized (systolic blood pressure less than 150 mmHg and diastolic blood pressure less than 100 mmHg) and adequate diuresis was noted. Group 2 was treated in a similar manner but with the addition of oral nifedipine, 10 mg every 4 hours postpartum for 48 hours. Group 3 underwent an ultrasound- directed curettage immediately following delivery in the delivery/operating room and was then treated as in group 1. All three groups were assessed postpartum for mean arterial pressure (MAP) and urine output (UO) every 2 hours, hematocrit and platelet count every 6 hours, and lactic dehydrogenaselaspartate aminotransferase every 12 hours for 48 hours postpartum.

RESULTS: Fifteen women were assigned to each of the three treatment groups. The MAP decreased significantly (P < .0001) in all three groups during the first 48 hours postpartum. Treatment interaction indicated specific differences among the groups. Standard therapy (group 1) was significantly inferior to nifedipine (group 2) and curettage (group 3) in regard to MAP decrease (P = .0017) and UO increase (P = .0137). No statistical differences existed between nifedipine and curettage. The rise in the platelet count following delivery was significantly different among the three groups (P = .033), with a much more rapid recovery in the curettage group (12-18 hours) than in the other groups (P = .0106).

CONCLUSIONS: Nifedipine and uterine curettage both appear to accelerate recovery from severe preeclampsia, as measured by MAP and UO. Uterine curettage appears the most effective in rapidly resolving the thrombocytopenia associated with severe preeclampsia. (J Soc Gynecol Invest 1994;1:210-4)

Keywords

Preeclampsia uterine curettage nifedipine mean arterial pressure urine output blood pressure.

Get full access to this article

View all access options for this article.

References

American College of Obstetricians and Gynecologists. Management of preeclampsia. ACOG technical bulletin No. 91. Washington, DC: American College of Obstetricians and Gynecologists, 1986.

Ploulin PF , Chatellier G. , Breart G. , et al. Frequency and perinatal consequences of hypertensive disease of pregnancy. Adv Nephrol 1986;57:69-74.

Lopez-Llera M. , Horta Jlh. Perinatal mortality in eclampsia . J Reprod Med 1972;8:281-7.

Pritchard JA , Pritchard SA Standardized treatment of 154 consecutive cases of eclampsia. Am J Obstet Gynecol 1975 ; 123:543-52.

Robinson HA , Schelin EC , Fort WD Postpartum curettement for hypertension. Am J Obstet Gynecol 1964 ;88:788-90.

Hunter CA Jr , Howard WF , McCormick CO Jr. Amelioration of the hypertension of toxemia by postpartum curettage. Am J Obstet Gynecol 1961;81:884-9.

Magann EF , Martin JN Jr , Isaacs JD , Perry KG Jr , Martin RW , Meydrich EF Immediate postpartum curettage: Accelerated recovery from severe preeclampsia . Obstet Gynecol 1993;81:502-6.

Barton JR , Heitt AK , Conover WB The use of nifedipine during the postpartum period in patients with severe preeclampsia. Am J Obstet Gynecol 1990 ;162:788-92.

Walters Bnj , Redman Cwg. Treatment of severe pregnancy-associated hypertension with the calcium antagonist nifedipine. Br J Obstet Gynaecol 1984;91:330-6.

10.

Pritchard JA , MacDonald PC , Gant NF , eds. Hypertensive disorders in pregnancy. In: Williams obstetrics. 17th ed. Norwalk, Connecticut: Appleton-Century-Crofts , 1985: 525-60.

11.

Lin CC , Lindheimer MD , River P. , Moawad AH Fetal outcome in hypertensive disorders of pregnancy. Am J Obstet Gynecol 1982;142:255-60.

12.

Papadakos PJ , Johnson DS , Abramowicz JS , Sherer DM Adult respiratory distress syndrome: A consideration with rapid respiratory decompensation in association with preeclampsia. Am J Crit Care 1993;2:65-7.

13.

Liu WJ , Fang SM Pregnancy induced hypertension complicated with cerebrovascular accidents . Chung-Hua Fu Chan Ko Tsa Chih 1993;28:31-3.

14.

Royburt M. , Siedman DS , Serr DM , Mashiach S. Neurologic involvement in hypertensive disease of pregnancy. Obstet Gynecol Surv 1991;46:656-64.

15.

Sibai BM , Taslimi M. , Abdella TN , Brooks RF , Spinatto JA , Anderson GD Maternal and perinatal outcome of conservative management of severe preeclampsia in midtrimester. Am J Obstet Gynecol 1985;152:32-7.

16.

Kalur JS , Martin JN Jr , Kirchner KA , Morrison JC Postpartum preeclampsia-induced shock and death: A report of three cases. Am J Obstet Gynecol 1991;165:1362-8.

17.

Hanretty K. , Whittle M. , Howie C. , Rubin P. Effect of nifedipine on Doppler flow velocity waveforms in severe preeclampsia. Br Med J 1989;299:1205-6.

18.

Mari G. , Kirshon B. , Moise K. , Lee W. , Cotton D. Doppler assessment of the fetal and uteroplacental circulation during nifedipine therapy for preterm labor. Am J Obstet Gynecol 1989;161:1514-8.

19.

Sibai BM , Barton JR , Akl S. , Sarinoglu C. , Mercer BM A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. Am J Obstet Gynecol 1992 ;167:879-84.

20.

Martin JN Jr, Blake PG , Lowry SL , Perry KG Jr, Riles JC , Morrison JC Pregnancy complicated by preeclampsia/ eclampsia with the syndrome of hemolysis, elevated liver enzymes, and low platelets: How rapid is postpartum recovery ? Obstet Gynecol 1990;76:737-41.