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Summary and conclusionHypertensive disorders of pregnancy are the leading cause of maternal and perinatal mortality and morbidity in developing and developed countries. The etiology of pre-eclampsia is still unknown. Delivering the baby is the only definite treatment. The benefits of acute pharmacological control of sever hypertension prior to and/or post-delivery are generally accepted. Most drugs commonly used in the management of severe pre-eclampsia have significant maternal and/or neonatal adverse side effects. Furthermore, some are not effective to acutely lower the blood pressure in patients with a hypertensive crisis. Until recently no one of the commonly used antihypertensive drugs has been tailored to the pathophysiology of severe preeclampsia, being a clinical syndrome characterized by endothelial cell dysfunction, vasospasm and platelet aggregation. Evidence exists that the use of antihypertensive drugs in pre-eclampsia is beneficial and treatment should aim at avoiding vascular damage due to blood pressure elevation without causing excessive reduction in blood pressure that would critically affect uteroplacental perfusion. Hydralazine is the agent most commonly used to control severe hypertension in pre-eclampsia. This agent is a potent vasodilator that acts directly on the vascular smooth muscle and may cause a drastic fall in blood pressure, consequently affecting placental blood flow. Hydralazine can also cause fluid retention, tachycardia and headache. Nifedipine has completely revolutioninzed the management of severe pre-eclampsia during the antenatal period and labour. Additionally, nifedipine acts rapidly and is long acting without causing serious side effects. The additional advantage of nifedipine to the fetus is in its ability to lower blood pressure without any apparent reduction in uteroplacental blood flow.In this study, a total of fourty patients with severe pre-eclampsia were selected from the outpatient clinic and inpatient ward, Obstetrics and Gynecology Department, Zagazig University Hospital. They were divided into two groups; the first group included twenty patients treated with IV hydralazine and the second group included twenty patients treated with sublingual nifedipine. Patients in both groups received IV magnesium sulphate as a loading dose followed by maintenance dose. Full history taking was done for all candidates. General, abdominal and local examinations were done. Routine laboratory investigations and ultrasound examination were done. Efficacy parameters, side effects, maternal outcome, mode of delivery and fetal outcome of both groups were recorded.In the present study, although both hydralazine and nifedipine could effectively control blood pressure, fewer doses of nifedipine were required to achieve blood pressure control.Nifedipine has faster onset of action when compared with hydralazine as the needed time to achieve effective blood pressure was shorter in nifedipine patients than hydralazine patients.Maternal hypotension may be more common with hydralazine, which was also associated with an excess of fetal distress, cesarean sections, and low Apgar scores.The concomitant use of nifedipine with magnesium sulphate did not cause postpartum haemorrhage nor hypotension.The most frequent side effects were headache in the nifedipine group, tachycardia and hypotension in hydralazine group, but non of them was serious enough to discontinue treatment.Nifedipine has the clinical advantage of being able to be given as required by midwives or nurses in the absence of doctor.Hydralazine is administered intravenously and needs strict monitoring, while the sublingual administration of nifedipine is easier, less demanding on hospital staff, more predictable, cheaper, more widely available and offers the advantage of convenience.Adequately powered clinical trials are needed to compare hydralazine with other short acting antihypertensive drugs to determine the most promising drug.From the results of the present study, we concluded that:• The results of this study generate uncertainty about the agent of first choice for treating severe pre-eclampsia.• Compared with hydralazine, nifedipine is effective being faster and given at fewer doses to achieve blood pressure control.• Nifedipine is more safe for mother and fetus.ReferencesAali, B.S. and Nejad, S.S. (2002): Nifedipine or hydralazine as a first-line agent to control hypertension in severe preeclampsia. Acta Obstetricia et Gynecologica Scandinavica; 81: 25-30.Abdel Wahab, W.; Frishman, W. and Landau, A. (1995): Management of hypertensive urgencies and emergencies. J Clin
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