Efficacy of Postpartum Furosemide Therapy on Blood Pressure Recovery in Patients with Severe Preeclampsia: A Randomized Clinical Trial
Background: Hypertensive disorders are an important cause of maternal mortality and morbidity, and severe preeclampsia is the most common cause [Baha M. Sibia, AJOG (2012)]. The blood pressure rises progressively during the first 5 days after delivery, and it is due to mobilization of 6-8 liters of liquid, and 950 meq of accumulated sodium,from interstitial and extravascular space to intravascular space[Davison JM and Dunlop W, Seminars in Nephrology,4:198–207 (1984)].Severe rising of blood pressure may lead to complications, such as renal failure, pulmonary edema, eclampsia, intracranial hemorrhage, stroke, coma and death [Baha M. Sibia, AJOG (2012)].Therefore, postpartum anti-hypertensive therapy can prevent these complications and diminishes maternal mortality and morbidity rate.
Objective: This investigation was done to evaluate whether a short course of postpartum furosemide therapy in patients with severe preeclampsia accelerates blood pressure recovery, reduces antihypertensive drugs usage, prevents complications such as eclampsia and finally diminishes hospitalization.
Study design: In a randomized clinical trial, 90 patients with severe preeclampsia participated. After spontaneous onset of diuresis and discontinuation of sulfate magnesium, patients were randomly allocated to receive either no therapy or 20 mg oral furosemide daily for five days with oral potassium supplementation. Postpartum blood pressure, the need for antihypertensive therapy, rate of complications and duration of hospitalization between treatment and control groups were compared.
Results: Mean systolic blood pressure on the third day after delivery was not different significantly between treatment and control groups(127.9±10.2 compared with 130 ± 11.5 mm-Hg, P=0.36). Mean diastolic blood pressure on the third day after delivery was not different between two groups. Patients in treatment group required less antihypertensive therapy during hospitalization (26.7% compared with 33.3%, P=0.64) but the difference was not significant. Eclampsia occurred in two patients in control group and not occurred in treatment group. Duration of hospitalization was not affected by the intervention.
Conclusion: Brief postpartum furosemide therapy in patients with severe preeclampsia may not be effective in postpartum blood pressure recovery and reducing the need for antihypertensive therapy. It may be useful to prevent complications such as eclampsia. Duration of hospitalization was not affected by the intervention.
Bangladesh Journal of Medical Science Vol.18(3) 2019 p.636-640
Copyright (c) 2019 Mona Shariati
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in the Bangladesh Journal of Medical Science agree to the following terms that:
- Authors retain copyright and grant Bangladesh Journal of Medical Science the right of first publication of the work.
Articles in Bangladesh Journal of Medical Science are licensed under a Creative Commons Attribution 4.0 International License CC BY-4.0.This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Authors are able to enter into separate, additional contractual arrangements for the distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted to post their work online (e.g., in institutional repositories or on their website) as it can lead to productive exchanges, as well as greater citation of published work.