الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 105 |  |  |
| | | from | 105 | | |
Abstract
Hypertensive disorders complicating pregnancy are common and form one of the deadly triad, along with hemorrhage and infection, that contribute greatly to maternal morbidity and mortality. The incidence of various hypertensive disorder of pregnancy varies widely from 5 to 15% throughout the globe. It accounts for a total of 7-10% of perinatal mortality in developed countries and 20% in developing countries. The perinatal mortality is 5% in mild PIH and 15 to 25% in severe PIH (Smitha et al., 2014).
Pre-eclampsia is a gestational hypertensive disorder affecting up to 6% of all gestations and is considered and well known as one of the major etiologies of maternal mortality and morbidity. Gestations that are developing PET are also considered to put women at an augmented long-term risk of cardiovascular disease and stroke (Al Qahtani. 2011).
Preeclampsia is a major medical disorder which jeopardises the health of mother and fetus. Preeclampsia decreases the perfusion of tissues and increases the risk of fetal mortality. Doppler sonography is used traditionally for assessing the fetal wellbeing. Ultra sound usage in the measurement of uteroplacental (UP) and fetal artery blood flow (FABF), new horizons are broadened in the avoidance and surveillance of fetal perfusion dysfunction.
The corner stone antihypertensive drug globally for the management of gestations with hypertensive disorders is α-methyldopa. Concerns are raised theoretically that, specifically in gestations clinically presented with pre-eclampsia, antihypertensive medications could have negative impact on uteroplacental blood flow by decreasing maternal peripheral blood pressure when there is existing raised uterine artery resistance. Past research studies exploring the impact of α-methyldopa on uterine artery Doppler parameters in gestations with hypertensive disorders included small numbers of study subjects and yielded conflicting results (Al-Azad et al. 2010).
When methyldopa causes somnolence and cannot be tolerated, alternatives such as the alpha-beta-adrenergic blocking agent, labetalol may be used. Clinical experience with labetalol is extensive and it is among the most widely used antihypertensive drugs in pregnancy (Sibai et al., 2005). Blood pressure and proteinuria fell significantly in a placebo controlled trial of labetalol in a cohort of 144 women with pregnancy induced mild and moderate hypertension. However, gestation was not significantly prolonged and measures of clinical outcome were not significantly altered in these women (Pickles et al., 2005). Possible advantages and no evidence of disadvantages for the fetus were reported in another trial with labetalol, this time a double blind controlled study in 152 women. Thus labetalol is generally not considered to adversely affect the fetus during the third trimester of pregnancy, and is commonly used to treat hypertension at that stage (Sibai et al., 2005).
Aim of this study was to clarify whether applying alpha-methyldopa treatment influences flow resistance in umbilical cord artery in pregnant women suffering from hypertensive disorders and comparing it with another evolving drug labetalol, which is not commonly used, in order to have alternative antihypertensive drug if there is shortage in methyl dopa in our country.
we conducted a study at the department of obstetrics and gynecology at sohag university hospital on 150 pregnant women who attended the obstetric out-patient clinic and emergency department with gestational age from 30-40 wks and all our patients were controlled by antihypertensive drugs for at least 3 weeks .
The study group was subdivided into three groups :-
group A and subdivision into :
Goup A1 : include 50 patients with PET ,chronic hypertension or gestational hypertension with pregnancy treated by antihypertensive drug Alph methyl dopa in the form of tablets (Methyl dopa 250 mg )(Kahira MSD company) and the blood pressure of our patients was controlled
group A 2 : included 50 patients treated by labetalol in the form of tablets (Labetalol 100mg ) (Al-Debeikypharma company)and the blood pressure of our patients was controlled .
group B : was include 50 normal controls with no medical or obstetric disorders to exclude any bias in the above two groups about the normal Doppler findings in the upper Egyptian women.
The mean age of our patients is 27 years with minimum 17 years and maximum of 41 year .
all of our patients were primigravidae in both groups.
Most of our patients were observed after 3 weeks of medication by Methyl dopa 50% were controlled on adose of 750 mg / day , while 50% were controlled on 1500 mg / day . And the Labetalol group controlled on adose of (300-400 mg) / day . The above table shows that the mean SBP of Methyl dopa group is 152.4 ± 8.2 while it is 141.2 ± 10.43 in the Labetalol group. It also shows that the mean DBP of Methyl dopa group is 98 ± 6.39 while it is 90.4 ± 4.85 in the Labetalol group.
Side effects are less common in Labetalol than Methyl dopa.
Both groups had significant albuminuria
All cases of control group (50 cases ) had no albumin in urine.
The mean gestational age by US findings of Methyl dopa group is 32.68 ± 2.85 while it is 32.24 ± 2.65 in the Labetalol group and 33.36±2.70 in control group. Mean age (28-33 weeks).
The mean estimated fetal weight of Methyl dopa group is 2.08±0.56 while it is 2.37±0.39 in the Labetalol group with highly significant difference between both groups, and it shows that the mean amniotic fluid (cm) of Methyl dopa group is 7.9±1.76 while it is 9.24±1.35 in the Labetalol group with very high significant difference between both groups.
Also the mean amniotic fluid is 8.57 with minimum 5 and maximum of 11. Additionally, we shows that the mean amniotic fluid (cm) of Methyl dopa group is 7.9 ± 1.76 while it is 9.24 ± 1.35 in the Labetalol group with very highly significant difference between both groups.
The mean (PI) is 1.3 with minimum 0.65 and maximum of 1.97 and the mean (S/D) is 2.63 with minimum 1.9 and maximum of 3.6. Additionally, the mean (RI) is 0.62 with minimum 0.49 and maximum of 0.9.
Also the mean (PI) of methyl dopa group is 1.17 ± 0.26 while it is 1.45 ± 0.32 in the labetalol group with no significant difference between both groups. The mean (S/D) of methyl dopa group is 2. 7 ± 0.5 while it is 2.53 ± 0.22 in the labetalol group with highly significant difference between both groups. We found also the mean (RI) of methyl dopa group is 0.61 ± 0.08 while it is 0.63 ± 0.06 in the labetalol group with no significant difference between both groups.
Conclusion
1. Present study showed that labetalol is more advantageous than methyldopa in terms of better and control of blood pressure.
2. There is no significant effect on fetoplacental blood flow with minimal side effects.