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Abstract
Hypertensive disorders of pregnancy are the leading cause of maternal and perinatal mortality and morbidity in developing and developed countries. The etiology of pre-eclampsia is still unknown. Delivering the baby is the only definite treatment. The benefits of acute pharmacological control of sever hypertension prior to and/or post-delivery are generally accepted. Most drugs commonly used in the management of severe pre-eclampsia have significant maternal and/or neonatal adverse side effects. Furthermore, some are not effective to acutely lower the blood pressure in patients with a hypertensive crisis. Until recently no one of the commonly used antihypertensive drugs has been tailored to the pathophysiology of severe preeclampsia, being a clinical syndrome characterized by endothelial cell dysfunction, vasospasm and platelet aggregation. Evidence exists that the use of antihypertensive drugs in pre-eclampsia is beneficial and treatment should aim at avoiding vascular damage due to blood pressure elevation without causing excessive reduction in blood pressure that would critically affect uteroplacental perfusion. Hydralazine is the agent most commonly used to control severe hypertension in pre-eclampsia. This agent is a potent vasodilator that acts directly on the vascular smooth muscle and may cause a drastic fall in blood pressure, consequently affecting placental blood flow. Hydralazine can also cause fluid retention, tachycardia and headache. Nifedipine has completely revolutioninzed the management of severe pre-eclampsia during the antenatal period and labour. Additionally, nifedipine acts rapidly and is long acting without causing serious side effects. The additional advantage of nifedipine to the fetus is in its ability to lower blood pressure without any apparent reduction in uteroplacental blood flow