ACCELERATED RECOVERY FROM SEVERE PREECLAMPSIA - UTERINE CURETTAGE VERSUS NIFEDIPINE

OBJECTIVE: We investigated the ability of uterine curettage and nifedi pine to accelerate postpartum recovery from severe preeclampsia. METHO DS: Forty-five parturients with severe preeclampsia weve randomly assi gned to one of three groups following delivery. Patients in group 1 we re managed with intravenous magnesium sulfate (2 g/hour) and observed in the obstetric recovery room until blood pressure had stabilized (sy stolic blood pressure less than 150 mmHg and diastolic blood pressure less than 100 mmHg) and adequate diuresis war noted. Group 2 was treat ed in a similar manner but with the addition of oral nifedipine, 10 mg every 4 hours postpartum for 48 hours. Group 3 underwent an ultrasoun d-directed curettage immediately following delivery in the delivery/op erating room and was then treated as in group 1. All three groups were assessed postpartum for mean arterial pressure (MAP) and urine output (UO) every 2 hours, hematocrit and platelet count every 6 hours, and lactic dehydrogenase/aspartate aminotransferase every 12 hours for 48 hours postpartum. RESULTS: Fifteen women were assigned to each of the three treatment groups. The MAP decreased significantly (P < .0001) in all three groups during the first 48 hours postpartum. Treatment inte raction indicated specific differences among tile groups. Standard the rapy (group 1) was significantly inferior to nifedipine (group 2) and curettage (group 3) irt regard to MAP decrease (P = .0017) and UO incr ease (P = .0137). No statistical differences existed between nifedipin e and curettage. The vise in the platelet count following delivery was significantly different among the three groups (P = .033), with a muc h more vapid recovery in the curettage group (12-18 hours) than in the other groups (P = .0106). CONCLUSIONS: Nifedipine and uterine curetta ge both appear to accelerate recovery from severe preeclampsia, as mea sured by MAP and UO. Uterine curettage appears the most effective in r ay idly resolving the thrombocytopenia associated with severe preeclam psia.