prostaglandin-a1 and Pre-Eclampsia

The presence of severe pregnancy-induced hypertension at the onset of labor requires therapy with a potent hypotensive agent. Prostaglandin A1 is a powerful vasodepressor that augments renal blood flow and glomerular filtration and possesses antiplatelet aggregator and oxytocic properties. A continuous intravenous infusion of prostaglandin A1 (40 to 50 micrograms/min) or dihydralazine (35 to 50 micrograms/min) was administered to 20 women with severe preeclampsia (10 in each group). The induced hypotensive response was similar with both drugs but the maximum reduction in blood pressure was achieved sooner with dihydralazine (4 hours) compared with prostaglandin A1 (7.5 hours). The more gradual hypotensive response is probably less dangerous on placental perfusion than a sudden change. Moreover, the oxytocic property of prostaglandin A1 shortened the time to delivery, which constitutes another potential advantage.

Topics: Blood Pressure; Dihydralazine; Female; Heart Rate; Heart Rate, Fetal; Humans; Infusions, Parenteral; Labor Stage, First; Pre-Eclampsia; Pregnancy; Prostaglandins A

The vasodepressor prostaglandin A1 appeared to offer a major clinical potential solution in cases of severe pregnancy-induced hypertension. Thirty pregnant women with severe pregnancy-induced hypertension and a low Bishop score were studied in three equal groups. Group 1 received prostaglandin A1 infusions alone (0.5 microgram/kg/min for a maximum of 24 hours). Group 2 had received initial priming by prostaglandin E2 vaginal gel 6 hours before the onset of the prostaglandin A1 infusion, and group 3 was treated by conventional therapy and oxytocin induction. In the first two groups blood pressure was reduced to normotensive values, and labor was induced satisfactorily in 15 of the 20 cases, but four patients in group 1 were delivered within 24 hours after infusion. Group 2 offered the most favorable results because 80% were delivered during the infusion; thus the postinfusion rebound rise in blood pressure was avoided. Group 3 presented the least acceptable results, with the highest failure rate and an increased number of operative deliveries.

Topics: Adult; Blood Pressure; Dinoprostone; Female; Heart Rate, Fetal; Humans; Labor, Induced; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Prostaglandins A; Prostaglandins E

Pilot studies showed that, i.v. infusions of the renal prostaglandin A1 (PGA1) induced a triad of beneficial clinical responses in severe pre-eclampsia; the blood pressure became normotensive, renal function was markedly improved and labour was successfully induced. The present study was an attempt to develop a therapeutic schedule of PGA1 administration in severe toxemia. Twenty one cases of severe pre-eclampsia (in 3 equal groups) received i.v. infusions of PGA1 in a dose range of 0.1-0.5 microgram/kgm/min for 12 - 24 hours and the B.P., uterine activity and FHR were continuously monitored during and for 12 hours following the infusion period. The 0.1 microgram/Kgm/min dose for 12 hours was inadequate while 0.5 microgram/Kgm/min for 12 hours induced a good hypotensive response and the cases delivered within 48 hours but a post-infusion rebound in hypertension was observed. The dose of 0.5 microgram/Kgm/min for 24 hours appeared to be optimal in clinical terms since a satisfactory effect on B.P. was recorded and all the subjects delivered normal babies during the infusion period with minimal or no post-infusion rebound rise in B.P. This approach holds a major potential in the treatment of severe pre-eclampsia.

Topics: Adolescent; Adult; Blood Pressure; Female; Fetal Heart; Heart Rate; Humans; Infant, Newborn; Infusions, Parenteral; Pre-Eclampsia; Pregnancy; Pregnancy Maintenance; Prostaglandins A; Proteinuria; Time Factors; Uterine Contraction