Preethi, B (2012) Comparison of efficacy of Labetalol Versus Alpha Methyl Dopa in the management of Pre eclampsia. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Pre Eclampsia is a multi-system disorder of unknown etiology, unique to pregnancy characterized by occurrence of Gestational Hypertension along with proteinuria after the 20th week of pregnancy in a previously normotensive and non-protienuric patient. Gestational Hypertension is defined as Systolic blood pressure of 140 mm of Hg or more and Diastolic blood pressure of 90 mm of Hg or more on two occasions, measured at least 6 hours apart but within 7 days. Proteinuria is defined as excretion of 0.3 g or more of protein in a 24 hour urine sample or >1+ on dipstick in a random sample after excluding urinary tract infection. Pre Eclampsia complicates 2-8% of pregnancies. Pre Eclampsia can affect virtually every organ system in the body and is a major cause of maternal and perinatal mortality and morbidity. Pre Eclampsia, when not controlled or left untreated can lead to catastrophes like Eclampsia, Abruptio placenta, HELLP syndrome, fetal growth restriction, and intrauterine fetal death. Though the definitive treatment of Pre Eclampsia is termination of pregnancy, aggressive treatment is necessary to ameliorate the disease progression in order to carry on the pregnancy till adequate fetal maturity is obtained. Oral anti hypertensive drugs have a major role in the management of Pre Eclampsia. A comparison is made here between Labetalol and the commonly used drug Alpha methyl dopa in the management of Pre Eclampsia. AIM OF THE STUDY: This study compares the efficacy of oral Labetalol versus oral Alpha methyl dopa in the management of Pre Eclampsia in terms of reducing the blood pressure, need for labour induction, mean birth weight, APGAR score and rate of neonatal admissions. MATERIALS AND METHODS: This randomized prospective comparative study was conducted at Institute of Social Obstetrics and Govt. Kasturba Gandhi Hospital for Women and Children, Triplicane, Chennai, on hundred patients, diagnosed as preeclampsia and admitted in the Eclampsia ward. Study Design: Prospective case control study. Duration of Study: From September 2010 to August 2011. METHODOLOGY: The patients included in this study were assigned to two groups at random of 50 patients in each group. GROUP 1: Tablet Alpha methyl dopa (Aldomet) 250 mg was given thrice daily. GROUP 2: Tablet Labetalol 100 mg was given twice daily. Inclusion Criteria: All patients with Gestational Hypertension (more than 20 weeks of gestation till term). • Systolic Blood Pressure of 140 mm of Hg or more. • Diastolic Blood Pressure of 90 mm of Hg or more. • Proteinuria ( 0.3 g in 24 hours or more/ 1+ dipstick or more). Exclusion Criteria: • Chronic Hypertension. • Renal Disease. • Liver Disease. • Bronchial Asthma. • GDM. • Cardiac Disease. • Imminent symptoms : _ Headache. _ Blurring. _ Epigastric pain. _ Oliguria(<500 mg/24 hrs). • Complications – _ Acute LVF. _ Coagulation failure. _ Intracerebral Hemorrhage. _ HELLP Syndrome. • Eclampsia. SUMMARY: This is a study comparing the efficacy of oral Labetalol and Alpha methyl dopa in the management of preeclampsia, carried out in ISO KGH. • The time duration of the study was from September 2010 to August 2011. • 100 patients diagnosed as preeclampsia and admitted to ISO KGH were included in this study. • Inclusion criteria included those who came under the definition of preeclampsia. • Exclusion criteria included those who had pre-existing medical disorders, those who had features of imminent Eclampsia, Eclampsia and those who developed complications of preeclampsia like acute left ventricular failure and HELLP syndrome. • These 100 patients were assigned to two groups at random of 50 patients in each group. Group 1 was started on tablet Alpha methyl dopa 250 mg thrice daily and Group 2 was started on tablet Labetalol 100 mg twice daily. Blood Pressure and proteinuria was recorded every 12th hourly. • The treatment was continued till delivery if the blood pressure is controlled. If the blood pressure was not controlled within 48 hours, the dose of drugs was doubled. • The relationship of age, parity, gestational age and body mass index to prevalence of preeclampsia in both the groups has been analyzed. Also the fall in BP after 48 hrs, need to increase the dose of the drugs, need for labour induction, method of delivery, blood pressure at the time of delivery, birth weight, APGAR score and neonatal admissions in each group has been analyzed. CONCLUSION: This is a study comparing the efficacy of Labetalol and Alpha methyl dopa in the management of preeclampsia, in which 50 patients were started on oral Labetalol and 50 patients were started on oral Alpha methyl dopa. • Significant fall in the diastolic blood pressure after 48 hrs occurred only in the labetalol group (p = 0.007). • In the Alpha methyl dopa group, there was a significant need to increase the dose of the drug after 48 hrs (p = 0.043). • There appears to be no significant difference in the rate of induction between the two groups (p =0.585). • The mean birth weight was significantly higher (p = 0.00) in the labetalol group (3.11 kg) compared to the alpha methyl dopa group (2.67 kg). • There was no significant difference in the APGAR scores (p = 0.090) and rate of neonatal admissions (p =0.240) in both the groups.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparison ; efficacy ; Labetalol ; Alpha methyl dopa ; management ; pre eclampsia. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 09:55 |
| Last Modified: | 10 Dec 2017 03:54 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4072 |
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