when to give hydralazine - mestep1

[ArchivalUser]

in a case of eclampsia..38 wks of pregnancy, seizure and BP 188/108mm hg?
Mgso4 only or hydralazine + Mgso4

[ArchivalUser]

if hypertension does not respond to mgso4 then give hydralaz.ine

[ArchivalUser]

It depends on classification:
Mild Preeclampsia:
Blood pressure 140/90 mm Hg but < 160/110 mm Hg on two occasions at least 6 hours apart while the patient is on bed rest
Proteinuria 300 mg/24 h but < 5 g/24 h
Asymptomatic

Severe :
Blood pressure 160 mm Hg systolic or 110 mm Hg diastolic on two occasions at least 6 hours apart while the patient is on bed rest.
Proteinuria of 5 g or higher in 24-hour urine specimen or 3+ or greater on two random urine samples collected at least 4 hours apart.
Oliguria < 500 mL in 24 hours
Cerebral or visual disturbances
Pulmonary edema or cyanosis
Epigastrica or right upper quadrant pain
Impaired liver function
Thrombocytopenia
Fetal growth restriction



Management:

Mild Preeclampsia

Women with mild preeclampsia are hospitalized for further evaluation and, if indicated, delivery.

If mild preeclampsia is confirmed and the gestational age is 40 weeks or greater, delivery is indicated.

At gestational ages of 37“40 weeks, cervical status is assessed and, if favorable, induction is initiated.

If the cervical status is unfavorable, preinduction cervical ripening agents are used as needed.

Occasionally, women with very unfavorable cervical examinations between 37 and 40 weeks may be managed expectantly for a limited time with bed rest, antepartum fetal surveillance, and close monitoring of maternal condition, including blood pressure measurement every 4“6 hours and daily assessment of patellar reflexes, weight gain, proteinuria, and symptoms. A complete blood count and levels of serum transaminases, lactate dehydrogenase, and uric acid should be checked weekly to twice weekly. Delivery is indicated if the cervical status becomes favorable, antepartum testing is abnormal, the gestational age reaches 40 weeks, or evidence of worsening preeclampsia is seen. If expectant management is undertaken after 37 weeks, the patient should understand that the only known benefit is a possible reduction in the rate of cesarean birth.

Women with mild preeclampsia before 37 weeks are managed expectantly with bed rest, twice-weekly antepartum testing, and maternal evaluation as described. Corticosteroids are administered if the gestational age is less than 34 weeks; amniocentesis is performed as needed to assess fetal pulmonary maturity. When extended expectant management is undertaken, fetal growth is assessed with ultrasound every 3“4 weeks. Occasionally, outpatient management is reasonable in carefully selected, reliable, asymptomatic patients with minimal proteinuria and normal laboratory test results. This approach includes bed rest at home, daily fetal movement counts, twice-weekly antepartum testing, serial evaluation of fetal growth, and frequent assessment, often by a visiting nurse, of blood pressure, proteinuria, weight gain, patellar reflexes, and symptoms. Any evidence of disease progression constitutes an indication for hospitalization and consideration of delivery. Regardless of severity, all women with preeclampsia at the University of Southern California receive prophylactic intrapartum magnesium sulfate to prevent convulsions. The benefit of prophylactic magnesium sulfate in preventing convulsions in patients with mild preeclampsia has not been demonstrated conclusively in the literature.

Severe Preeclampsia

Severe preeclampsia mandates hospitalization. Delivery is indicated if the gestational age is 34 weeks or greater, fetal pulmonary is confirmed, or evidence of deteriorating maternal or fetal status is seen. Acute blood pressure control may be achieved with hydralazine, labetalol, or nifedipine. The goal of antihypertensive therapy is to achieve a systolic blood pressure < 160 mm Hg and a diastolic blood pressure < 105 mm Hg. Overly aggressive control of the blood pressure may compromise maternal perfusion of the intervillous space and adversely impact fetal oxygenation. Hydralazine is a peripheral vasodilator that can be given in doses of 5“10 mg IV. The onset of action is 10“20 minutes, and the dose can be repeated in 20“30 minutes if necessary. Labetalol can be administered in doses of 5“20 mg by slow IV push. The dose can be repeated in 10“20 minutes. Nifedipine is a calcium channel blocker that can be used in doses of 5“10 mg orally. The sublingual route of administration should not be used. The dose can be repeated in 20“30 minutes, as needed.

Management of severe preeclampsia before 34 weeks is controversial. In some institutions, delivery is accomplished regardless of fetal maturity. At the University of Southern California, delivery often is delayed for a limited period of time to permit the administration of corticosteroids. Magnesium sulfate is initiated, fetal status is monitored continuously, and antihypertensive agents are used as needed to maintain a systolic blood pressure < 160 mm Hg and a diastolic blood pressure < 105 mm Hg. Between 33 and 35 weeks, consideration should be given to amniocentesis for pulmonary maturity studies. If mature, immediate delivery is indicated. If immature, corticosteroids are administered and, if possible, delivery is delayed 24“48 hours. Between 24 and 32 weeks, antihypertensive therapy is instituted as indicated, corticosteroids are administered, and extensive maternal counseling is undertaken to clarify the risks and benefits of pregnancy prolongation. Neonatology consultation is helpful to delineate the neonatal risks specific to gestational age and estimated fetal weight. The duration of expectant management is determined on an individual basis, taking into account maternal wishes, estimated fetal weight, gestational age, and maternal and fetal status. Expectant management is contraindicated in the presence of fetal compromise, uncontrollable hypertension, eclampsia, DIC, HELLP syndrome, cerebral edema, pulmonary edema, or evidence of cerebral or hepatic hemorrhage. When severe preeclampsia is diagnosed before 24 weeks of gestation, the likelihood of a favorable outcome is low. Thorough counseling should address realistically the risks and anticipated benefits of expectant management and should include the option of pregnancy termination. If an appropriately informed patient declines the option of pregnancy termination, expectant management should proceed as outlined above.