Severe preeclampsia: is vasodilation therapy with hydralazine dangerous for the preterm fetus?
Increasing experimental and clinical evidence points to a subset of severe preeclamptic women who are hypovalemic with a low cardiac index and a high systemic vascular resistance, and in whom vasodilatory therapy may cause precipitate falls in maternal perfusion pressure, unless anticipated by prior correction of the hypovolemia. Since there is a paucity of adequately controlled clinical trials with appropriate definitions of hypotension or perinatal outcome, the consequences of such episodes for the preterm fetus are unknown. Epidemiologic evidence, using a logistic regression analysis model, is reviewed, which points to an association between a hypotensive episode following a commonly used drug, hydralazine, and a worse perinatal outcome in a study of severely hypertensive women delivered less than 32 weeks. An estimate of this risk, using the odds ratio, is 5.97 (95% confidence interval 1.84 to 19.35).
Adelaide Medical Centre for Women and Children, Queen Victoria Hospital, Rose Park, South Australia.
R J
RJ
Derham
J
J
Robinson
D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D006830:Hydralazine / Q000009:adverse effects*; D007022:Hypotension / Q000139:chemically induced*; D011225:Pre-Eclampsia / Q000188:drug therapy*; D011247:Pregnancy
D006830:Hydralazine