COMPARISON OF INTRAVENOUS LABETALOL AND ORAL NIFEDIPINE IN MANAGEMENT OF BLOOD PRESSURE IN PATIENTS WITH SEVERE PREGNANCY INDUCED HYPERTENSION

METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group–B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational definition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying ttest and consider significant at p value <5%. It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a significant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more effective.


COMPARISON OF INTRAVENOUS LABETALOL AND ORAL NIFEDIPINE IN
METHODOLOGY: This randomized control trial was done in Obstetrics and Gynaecology department of Hilal-e-Ahmer hospital, Faisalabad over a period of 6 months from 01-07-2016 to 31-12-2016. Total 100 patients (group-A and group-B having 50 in each) were included in study. In group A, females were given 40mg oral Nifedipine and in group, females were given 20ml intravenous Labetalol. Time at administration was followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 min. The total donation time to achieve B.P was noted (as per operational definition).The collected data was analyzed by using SPSS version 17.0. Baseline blood pressure were presented in the form of mean+SD. Both groups were compared for mean time to achieve blood pressure control by applying t-test and consider significant at p value <5%.
It is estimated that 6-12% of all the pregnancies are complicated by hypertension and even all improvements pre eclempsia is a significant reason of maternal and perinatal morbidity and mortality worldwide. Nifedipine, Labetalol and hydralazine are mostly being used in acute management of hypertension in pregnancy but so far there is no evidence that anyone drug is more effective. were excluded from study. Approval of hospital ethical committee was taken. One hundred patients who fulfill the selection criteria were enrolled in the study a f t e r t a k i n g i n f o r m e d c o n s e n t . T h e i r demographic data (name, age, gestational age, parity, baseline blood pressure) was recorded. The females were divided in two groups by using random number table. In group A, females were given 40mg oral Nifedipine and in group B, females were given 20ml intravenous labetalol. Time of administration of trail drugs noted. Then females were followed in the ward for assessment of blood pressure control. Blood pressure was noted after every 10 minutes. The total duration of time to achieve BP control was noted (as per operational definition). All the information was in the Pro forma (attached). SPSS 17.0 version was for data analysis. Quantitative variables like age, gestational age and total time to achieve control were presented as mean and standard deviation. Independent sample t-test was used to compare the mean time to achieve BP control in both groups. P value <0.05 was considered statistically significant.

RESULTS
In this study 100 patients were included and further divided in two groups (50 in each group). There is 76%(n=38) patients lies in

RESULTS:
Rationale of this is to identify a safe, easy to use a n d c o s t e ff e c t i ve r e g i m e n t o c o n t r o l hypertensive crises especially in developing countries like Pakistan. Results of this study may escort the concerned professionals towards a better management of PIH leading to prevention of associated morbidity and mortality.
leading cause of direct maternal death, six in [3] latest triennial report . The complications of uncontrolled high blood pressure during pregnancy affects multiple organ systems and can be detrimental to both mother and fetus like [ 4 ] pre-eclempsia, eclempsia and stroke . Antihypertensive therapy should be for severe hypertension women's to low down for blood [ 5 ] pressure  [6] hydralazine in randomized controlled trials . The use of anti-hypertensive drugs in [7] pregnancy is controversial . It has been expressed that antihypertensive treatment in pregnancy with labetalol may can possibly h i n d e r f e t a l c o n d u c t i n l o w e r d e g r e e hypertensive malady of pregnancy when contrasted with Nifedipine. Prime attention must balance the possibly inconsistent risks and [8] assistances to mother and fetus .Recent guidelines also listed hydralazine, Nifedipine and labetalol as first-line alternatives for reducing blood pressure in pregnancy induced [ 9 ] hypertension . Pregnant women needed severe control on their blood pressure under case of severe pregnancy induced hypertension to avoid life threats like eclempsia, HELLP syndrome, shock etc. Oral Nifedipine is more effective for safely reducing the blood pressure to target levels compared with intravenous labetalol. Therefore oral Nifedipine can be an alternative to intravenous labetalol for lowering b l o o d p r e s s u r e d u r i n g h y p e r t e n s i v e emergencies in pregnancy. Oral may also be preferable because of its ease of oral administration, lower price and a smooth treating schedule.
Independent sample t-test shows mean time to achieve BP control in both groups was recorded as 31.24+5.62 minutes in Group-A and 45.5+4.63 minutes in Group-B, it shows significant mean difference between both groups at p value 0.001 (Table -III).    [11] al compared pre-eclempsia between 26-36 weeks of gestation bed rest with oral Nifedipine in 200 women and find out significant reduction occurred in the diastolic and systolic blood pressures with Nifedipine, also reduce the numbers of severe hypertension deliveries.

DISCUSSION:
Current study demonstrated that mean time to achieve blood pressure control significantly shorter with oral Nifedipine when compared with intravenous labetalol (p<0.05). We compared our results with a randomized control trial where the study reported that time taken to achieve blood pressure control was 35 vs.42 min for oral Nifedipine and intravenous labetalol [ 1 2 ] respectively (p=0.37) . Another pooled analysis of seven trial also showed that oral Nifedipine is as efficacious and safe as labetalol and may have less reported maternal side [13] [ 14] effects . S Shekhar at al determined the efficacy and safety of oral Nifedipine for treatment of severe hypertension of pregnancy compared with intravenous labetalol and concluded with oral Nifedipine is as efficacious and safe as intravenous labetalol and may have an edge in low resource settings. Going forward, the ability of Nifedipine need to be tested in muti-centers so that racial and ethnic differences may also be controlled. The other aspect need to be evaluated, is the preference of oral Nifedipine use in multiple gestation and patients with systemic disorders i.e. gestational diabetes, cardiovascular disorders.

ETHICAL REVIEW COMMITTEE:
Ethical review committee of the said institute has reviewed and approved this article.
We concluded that the mean time to achieve blood pressure control was shorter with oral Nifedipine when compared to intravenous labetalol for the management of severe PIH.