Intravenous nicardipine for severe hypertension in pre-eclampsia - effectsof an acute treatment on mother and foetus

Objectives: To assess the efficacy in lowering blood pressure, and the safe ty for mother and foetus of an acute nicardipine therapy in severe pre-ecla mpsia. Design: Prospective clinical study. Setting: One university hospital obstetric unit. Patients: Twenty consecutive adult pre-eclamptic patients with severe hyper tension. Intervention: Nicardipine, 1 mu g/kg per min, was given intravenously to lo wer the mean arterial pressure (MAP) by at least 15%. Then, the dosage was reduced by 1/3, and the final dosage was determined to maintain MAP at 20-3 0% below the initial value, by increasing or decreasing the infusion rate b y 0.5 mg/h. Measurements and results: Maternal MAP and heart rate (HR) were assessed ev ery 5 min for 1 h. Foetal HR (FHR) was recorded throughout the study period and assessed for Fischer score. Gestational age, Apgar scores, birth weigh t, capillary filling time and the duration of stay in the paediatric intens ive care unit (ICU) were used to evaluate the short-term perinatal outcome. A 15-30% decrease in MAP occurred within 15-20 min in all patients. An inc rease in HR was noted, and two patients had severe tachycardia. Maternal si de effects included flushing, headache, nausea and dizziness. FHR showed a transient decrease in acceleration episodes and occurrence of decelerations . No ni cardipine-related foetal distress occurred. Four infants born durin g the study period did well at birth and had a good outcome. Conclusions: Acute nicardipine therapy can induce severe maternal tachycard ia. No severe foetal or neonatal adverse effects occurred. This dose scheme requires comparison with alternative therapeutic options.