Maternal and fetal effects of intravenous nimodipine in severe preeclamptic pregnants

Öz

Objective: The aim of this study is to investigate on maternal and fetal effects of calcium channel blocker nimodipine which is an effective cerebral vasodilator, in severe preeclamptic women. Material and Methods: The effects of intravenous nimodipine on side effects, maternal prodromal symptoms, arterial blood pressure and fetal umblical artery doppler indices were assessed on ten patients hospitalized for severe preeclampsia. Results: At hospitalization seven patients had headache, one had visual disturbances, one had nausea and vomiting. One patient had headache prior to hospitalization. Following the infusion of nimodipine the symptoms of all patients with headache.was disappeared one hour later. Patients with nausea and vomiting and visual disturbances also had significant amelioration of their symptoms two hours later. In two patients that had minor headache following the infusion of the drug, but the symptom regressed in 15 minutes. When arterial blood pressure was evaluated at 0,1, 2 and 3 hours post infusion of nimodipine there was a significant fall in blood pressure at 3 hours(p0.05). None of the patients had convulsions during nimodipine treatment. Conclusion: Nimodipine removes headache and visual disturbances which are common Symptoms seen in severe preeclampsia. Since it has few side effects and does not require intense monitorization, it may be used instead of magnesium sülfat for prophylaxis of eclampsia. However large studies are needed to prove the effectiveness of the drug.

Anahtar Kelimeler

• Pre-Eclampsia,Nimodipine,Injections, Intravenous,Prospective Studies,Headache,Vision Disorders

Ağır preeklamptik gebelerle intravenöz nimodipin'in maternal ve fetal etkileri

Öz

Amaç: Ağır preeklamptik gebelerde etkin bir serebral vazodilatatör olan kalsiyum kanal blokeri nimodipin'in anne ve fetüs üzerine etkilerini araştırmaktır. Materyel ve Metod: Ağır preeklampsi nedeniyle hastaneye yatırılan on gebede intravenöz (IV) nimodipin tedavisinin yan etki, maternal prodromal belirtiler, arterial kan basıncı ve fetal umblikal arter doppler indeksleri üzerine etkisi değerlendirildi. Bulgular: Başvuru anında yedi hastada başağrısı, bir hastada görme bozukluğu, bir hastada bulantı ve kusma mevcuttu. Bir hastada ise başvuru öncesi başlayan baş ağrısı mevcuttu. IV nimodipin tedavisi başladıktan bir saat sonra hastaların tamamında baş ağrısı ortadan kalktı. Görme bozukluğu olan hastada ve bulantı ve kusması olan hastada semptomlar tedaviye başladıktan 2 saat sonra geriledi. İki hastada tedavi başladıktan sonra oluşan ancak rahatsız edici olmayan başağrısı 15 dakika sonra kayboldu. IV nimodipin infüzyonu sonrası 0., 1., 2. ve 3. saatlerde arterial kan basıncı değerlendirildiğinde, 3. saatte arterial kan basıncında anlamlı düşüş olduğu saptandı (p0.05). Nimodipin tedavisi sırasında hiçbir hastada konvülzüyon görülmedi. Sonuç: Nimodipin ağır preeklampsinin sık görülen belirtilerinden baş ağrısı ve görme bozukluğunu ortadan kaldırmaktadır. Yan etki azlığı ve yakın monitörizasyon gerektirmemesi nedeniyle eklampsi proflaksisinde magnezyum sülfat tedavisi yerine kullanılabilir. Ancak etkinliğinin ortaya konması için daha geniş hasta gruplarında yapılacak araştırmalara ihtiyaç vardır.

Anahtar Kelimeler

• Preeklampsi,Nimodipin,Enjeksiyon, ven içi,İleriye dönük çalışma,Baş ağrısı,Görme bozuklukları

Kaynakça

1. 1. Magpie Trial Collaboration Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomized placebo-controlled trial. Lancet 2002;359:1877-90
2. 2. Will AD, Lewis KL, Hinshaw DB. Cerebral vasoconstriction in toxemia. Neurology 1987;37:1555-57
3. 3. Trommer BL, Homer D, Michael MA. Cerebral vasospasm and eclampsia. Stroke 1988; 19:326- 29
4. 4. Horn EH, Filshie M, Kerslake RW, Jaspan T, Worthington BS, Rubin PC. Widespread cerebral ischemia treated with nimodipine in a patient with eclampsia. BMJ1990;301:794
5. 5. Van den Veyver IB, Belfort MA, Rowe TF, Moise KJ. Cerebral vasospasm in eclampsia: transcranial doppler ultrasound findings. J Maternal Fetal Med 1994;3:9-13
6. 6. Bayhan G, Araş Z, Aban M, Yalinkaya A, Yayla M, Erden AC. Preeklampsidefenitoin ve magnezyum sülfat tedavilerinin karşılaştırılması. Perinataloji dergisi 2000;8(4):83-87
7. 7. Belfort MA, Saade GR, Moise KJ, CruzA, Adam K, Kramer W, Kirshon B. Nimodipine in the management ofpreeclampsia: maternal and fetal effects. Am J Obstet Gynecol 1994; 171:417-24
8. 8. Kaplan PW. The neurologic consequences of eclampsia. Neurologist 2001 ;7(6):357-63

9. 9. Ben Salem F, Ben Salem K, Grati L, Arfaoui C, Faleh R, JmelA et al. Risk factors for preeclampsia: a case control study. Ann Fr Anesth Reanim 2003; 22:865-69
10. 10. Coetzee EJ, Dommisse J, Anthony J. A randomised controlled trial of intravenous magnesium sulphate versus placebo in the management of women with severe pre-eclampsia
11. Br J Obstet Gynecol 1998;105(3):300-03
12. 11. Sibai BM. Magnesium sulfate prophylaxis in preeclampsia: lessons learned from recent trials
13. Am J Obstet Gynecol 2004;190:1520-26
14. 12. Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol 2005;105(2):402-10
15. 13. Belfort MA, Saade GR, and Moise KJ Jr. The effect of magnesium sulfate on maternal and fetal blood flow in pregnancy-induced hypertension
16. Acta Obstet Gynecol Scand 1993;72: 526-30
17. 14. Anthony J, Mantel G, Johanson R, Dommisse J
18. The haemodynamic and respiratory effects of intravenous nimodipine used in the treatment of eclampsia. BrJ Obstet Gynecol 1996;103(6):518-22
19. 15. Duley L, Gülmezoğlu AM, Henderson-Smart DJ. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev 2003;(2):25 16. Belfort MA, Grunewald C, Saade GR, Varner MW, Nisell H. Preeclampsia may cause both overperfusion and underperfusion of the brain: a cerebral perfusion based model. Acta Obstet Gynecol Scand 1999; 78(7):586-91
20. 17. Belfort MA, Varner MW, Dizon-Townson DS, Grunewald C, Nisell H. Cerebral perfusion pressure, and not cerebral blood flow, may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis. Am J Obstet Gynecol 2002;187(3):626-34
21. 18. Belfort MA, AnthonyJ, Saade GR, Allen JCJr, Nimodipine Study Group. A comparison of magnesium sulfate and nimodipine for the prevention of eclampsia. N Engl J Med 2003;348(4):304-ll
22. 19. Lu JF, Nigthingale CH. Magnesium sulfate in eclampsia and pre-eclampsia: pharmacokinetic principles. Clin Pharmacokinet 2000 Apr;38(4):305-14
23. 20. Riaz M, Porat R, Brodsky NL, Hurt H. The effects of maternal magnesium sulfate treatment on newborns: a prospective controlled study. J Perinatol 1998; 18:449-54