Steyn D W, Odendaal H J
Department of Obstetrics and Gynaecology, Tygerberg Hospital, South Africa.
Eur J Obstet Gynecol Reprod Biol. 1997 Dec;75(2):155-9. doi: 10.1016/s0301-2115(97)00123-1.
To compare the efficacy and safety of intravenous dihydralazine with ketanserin in the management of severe hypertension in the third trimester.
A double blind randomised controlled trial, comparing 5 mg dihydralazine with 10 mg ketanserin after an intravenous infusion of 500 ml of a crystalloid solution. Medication was repeated every 20 min till the therapeutic goal of 90 mm Hg was reached, to a maximum of 4 dosages. Main outcome measures were treatment failures and emergency deliveries for fetal distress.
The therapeutic goal was met more often in patients receiving dihydralazine (36/38 compared to 27/42; P < 0.01). The need for delivery for fetal distress did not differ (3 after dihydralazine, 1 after ketanserin, P = 0.29) No therapy related perinatal loss occurred, but one mother with an undiagnosed phaechromocytoma died 24 h after receiving dihydralazine.
Ketanserin in this dosage is less effective to lower diastolic blood pressure. The place of a fluid load prior to dihydralazine needs to be further investigated, as fetal heart rate decelerations were less common than previously reported.
