Labetalol works by slowing the heart rate and opening up blood vessels to improve blood flow and lower blood pressure. Thereafter, inpatient titration with labetalol hydrochloride tablets may proceed as follows. Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in preterm infants regardless of labetalol exposure. Neonatal side effects of maternal labetalol treatment in. High blood pressure can damage the kidneys, brain, blood vessels and heart. Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 4 of 32 flowchart. The recommended initial dose is 200 mg orally, followed in 6 to 12 hours by an additional dose of 200 or 400 mg orally, depending on the blood pressure response.
Labetalol an emerging firstline drug for pregnancyinduced. Glucose if alt150 rule out acute fatty liver of pregnancy. Labetalol versus nifedipine as antihypertensive treatment. We analyzed the possible association between intrauterine labetalol exposure and such side effects. Once diagnosed, youll be referred to a hospital specialist for further assessment and any necessary treatment. Diagnosis and management of preeclampsia american family. Intravenous labetalol is considered to be the primary drug of choice for the urgent. Pre eclampsia with severe hypertension andor with symptoms, andor biochemical andor. Quick reference guide reducing the risk of preeclampsia 3. Labetalol while pregnant welcome to the preeclampsia. Usually occurs between 20 weeks of gestation and about 6 weeks postpartum.
Raynauds phenomenon of the nipple as a sideeffect of. Secretion of labetalol in breastmilk of lactating women. The relative risk is 15 if preeclampsia occurs at 2033 weeks, 10 at 3336 weeks, and 8 after 37 weeks. Preeclampsia can only be cured by delivering the baby.
Preeclampsia is a pregnancy specific multisystem disorder of unknown etiology. The use of iv labetalol, iv hydralazine, or immediate release oral nifedipine for the treatment of acuteonset, severe hypertension for pregnant or postpartum patients does not require cardiac monitoring or other special monitoring beyond that which is outlined in the order sets in this document box 1, box 2, box 3, which describe time. Labetalol is one of the most commonly used antihypertensive medications for the treatment of hypertension during pregnancy, an increasingly common and leading cause of maternal mortality and. Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum. Hypertension in pregnancy wirral medicines management. The condition causes your blood pressure to become very high and can be lifethreateningly. If you have preeclampsia, youll be closely monitored until its possible to deliver the baby.
But if labetalol can keep pree at bay then make me there poster child. Pree w severe features previously known as severe preeclampsia u preeclampsia with severe features is preeclampsia with signs of end organ damage, or if blood pressures escalate to 160110 u. When it comes to hypertension or high blood pressure during pregnancy, it is a serious concern for both, the mother and the baby. Consider any pregnant woman admitted to icu as having preeclampsia until proven otherwise. Patients will be randomized to receive mgso4 therapy as given in their institution, versus oral labetalol 200mgq6 hours, from enrollment in. Labetalol has been reported to be a cause of raynauds phenomenon of the nipple. This risk is estimated to be less than 10% for all cases of preeclampsia,37 but is greater when preeclampsia is discovered before 28 weeks. It was classically defined as a triad of hypertension, oedema, and proteinuria, but a more modern definition of preeclampsia concentrates on a gestational elevation of blood pressure together with 0. Intravenous labetalol is the agent of choice for intravenous administration. Preeclampsia is a major cause of maternal mortality and morbidity, preterm birth, perinatal death. Labetalol, alphamethyldopa, preeclampsia, fetal surveillance.
We present a case in a pregnant woman with preeclampsia describing a burning sensation in her nipples after being administered labetalol, which resolved after nifedipine administration. Labetalol for hypertension in pregnancy request pdf. Hypertensive disorders of pregnancy refer to online version, destroy printed copies after use page 3 of 32 flow chart. Pre eclampsia and eclampsia are hypertensive disorders of pregnancy that cause significant morbidity and mortality in the mother and fetus both. Use of antihypertensive drugs during preeclampsia ncbi. Preeclampsia complicates up to 8% of pregnancies in the developed world. Hypertensive disorders are the most common medical disorders in pregnancy. Following reduction in bp commence labetalol infusion 5mg perml. Severe preeclampsia and eclampsia are relatively uncommon but can cause serious complications of pregnancy. Labetalol and nifedipine control mean systolic and diastolic bp to target in pregnant women with chronic hypertension. Gestational hypertension without preeclampsia reduced offspring ppvtr scores by 1.
Rarely can occur earlier than 20 weeks in patients with molar pregnancies. It is licensed for the treatment of mild to severe hypertension, hypertension in pregnancy and angina pectoris with existing hypertension. Labetalol is used to treat high blood pressure and chest pain. In addition, management of hypertension during pregnancy in chronic hypertensive. For details of administration and monitoring of iv labetalol and iv hydralazine, refer to guideline. Having a antiphospholipid antibody syndrome or collagen vascular disease predisposes to preeclampsia. However, this association is rare, and the incidence unknown. Good recruitment was demonstrated, and mechanistic treatment effects observed. Chips primary perinatal loss or high level neonatal care for 48 hours and secondary serious maternal complications outcomes, birthweight 110 mmhg or systolic blood pressure 160 mmhg on more than two occasions, with significant proteinuria. It has a particular indication in the treatment of pregnancyinduced hypertension which is commonly associated with preeclampsia. Hypertensive pregnant women, in whom the decision for delivery has been made, will be enrolled after written, informed consent. The incidence of preeclampsia ranges from 3% to 7% for nulliparas and 1% to 3% for multiparas.
For details of administration and monitoring of iv. Preeclampsia with severe hypertension andor with symptoms, andor biochemical andor. Community level interventions for preeclampsia clip working group. Preeclampsia is a serious condition that can occur during pregnancy. Labetalol is a nonselective betaadrenoceptor blocking drug betablocker with additional alpha adrenoceptor blocking properties. Quick reference guide reducing the risk of preeclampsia. All pregnant women, especially those at high risk see slide on aetiology have regular blood pressure and urinalysis checks.
Dr dj dalgleish consultant anaesthetist royal bournemouth and christchurch hospitals trust, uk key points hypertensive diseases of pregnancy are still a common cause of maternal death. It includes the infusion regimens for labetalol, hydralazine and magnesium sulphate. Management uncontrolled document when printed published. Angiotensin receptor agonistic autoantibodies induce preeclampsia in pregnant mice. Antepartum and postpartum preeclampsia and eclampsia. In the triennium 20062008 there were 19 maternal deaths resulting from severe preeclampsia and eclampsia. Do labetalol and methyldopa have different effects on. The risk of recurrence of preeclampsia during a subsequent pregnancy has to be considered. Fetal surveillance in pregnant women with hypertension 15. I was worried that the meds would lower the babys blood flows and heart rate. Antepartum and postpartum preeclampsia and eclampsia management in the emergency department ed treatment. Having a family history of preeclampsia, particularly in a firstdegree relative, puts a woman at higher risk.
Preeclampsia pe is a clinical entity characterized by either the new onset of. Update on the use of antihypertensive drugs in pregnancy. A comparison of hydralazine and labetalol in the management of. Management of preeclampsia and gestational hypertension 8. Management of hypertension before, during, and after pregnancy. This study provides support for a larger definitive trial scrutinizing the benefits and side effects of firstline antihypertensive treatment in. Labetalol is effective in the management of hypertensive emergencies, postoperative hypertension, pheochromocytomaassociated hypertension, and rebound hypertension from beta blocker withdrawal. Regional guideline for the management of pre eclampsia. The disorder affects approximately 5 to 7 percent of pregnancies and is a significant cause of maternal and fetal.
Hydralazine remains the drug of choice for women with asthma or congestive heart failure. Preeclampsia usually occurs after 20 weeks gestation and is a multisystem disorder. Control seizures control hypertension follow resuscitation. Emergent therapy for acuteonset, severe hypertension.
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