COMPARE THE FETOMATERNAL OUTCOME OF ORAL LABETALOL VERSUS LABETALOL WITH ORAL EATING MURRAYA KOENIGII/CURRY LEAVES (KADI PATTA) IN PREGNANCY INDUCED HYPERTENSION PATIENTS.

Main Article Content

Prof Dr Saher Fatima Fatima
Prof Dr Anjum Rehman
Dr Zeeshan Ahmed
Ms Ambreen Rehman
Ms Habiba Rehman

Keywords

Oral Labetalol, Curry Leaves (KadiPatta), Pregnancy induced hypertension

Abstract

OBJECTIVE:To compare the fetomaternal outcome of oral labetalol versus Labetalol with oral eating murraya koengii/curry leaves (KadiPatta) in pregnancy induced hypertensionpatients.


MATERIAL & METHOD: This cohort study was conducted from March 2019 to February 2022 at the Department of Obstetrics & Gynecology, Lyari General Hospital Karachi. All pregnant patients who were diagnosed with pregnancy induced hypertension, such systolic BP of ≤160mmHg or diastolic BP of ≤110mmHg admitted and case entry after written informed consent has been done. Chronic hypertension, history of cardiac abnormality, and intrauterine death were excluded before 28th week from this study. Preliminary results were measured for BP control and the number of doses needed. Secondary outcome measures were maternal complications of placental abruption, HELLP, and eclampsia.


RESULTS: A total of 1000 patients were recruited in this randomized controlled study. The mean age was 29.2±7.33 years in group A and 29.58±7.90 years in Group B. Most of the patients with a primigravida, 29.58±7.90 and 362(72.4%) were Group A and B respectively. Common maternal side effects encountered were palpitation seen in 66(13.2%) patients of Group-A and 44(8.8%) patients in Group-B (p=0.021). Followed by headache were seen in 42(8.4%) patients of Group-A, 33(6.6%) patients of Group B. Placental Abruption in 42(8.4%) patients were observed in Group A, while in 25(5%) patients in Group B (p=0.213). Eclampsia was seen in 28(5.6%) patients in Group-A and 22(4.4%) patients developed eclampsia in Group B (p=0.011). In Labetalol Group, 67(13.4%) babies had APGAR Score ≤7 and 131(26.2%) babies required admission to NICU. In In labetalol with curry leaves group-B 56(11.2%) babies had Apgar score ≤7 & 106(21.2%) babies were admitted to NICU (p= 0.003). Early Neonatal Deaths and Intrauterine Death was observed 39(7.8%)  in labetalol with curry leaves group-B, followed by still birth in 8(1.6%)babies. While in group A 51(10.2%) babies were early neonatal deaths and 12(2.4%) babies still birth .


CONCLUSION: Oral labetalowith Curry Leaves (KadiPatta) is efficacious in controlling BP in patients with induced hypertension patients without any significant side effects.

Abstract 113 | pdf Downloads 53

References

1. Kintiraki E, Papakatsika S, Kotronis G, Goulis DG, Kotsis V. Pregnancy-induced hypertension. Hormones. 2015 Apr;14(2):211-23.
2. Ekele BA. Use of magnesium sulfate to manage pre-eclampsia and eclampsia in Nigeria: overcoming the odds. Ann Afr Med. 2009 Apr-Jun;8(2):73-5.
3. Audu LR, Ekele BA. A ten year review of maternal mortality in Sokoto, northern Nigeria. West Afr J Med. 2002 Jan-Mar;21(1):74-6.
4. El-Nafaty AU, Melah GS, Massa AA, Audu BM, Nelda M. The analysis of eclamptic morbidity and mortality in the Specialist Hospital Gombe, Nigeria. J ObstetGynaecol. 2004 Feb;24(2):142-7.
5. Upadya M, Rao ST. Hypertensive disorders in pregnancy. Indian J Anaesth. 2018;62(9):675–681.
6. Granger JP, Alexander BT, Bennett WA, Khalil RA. Pathophysiology of pregnancy-induced hypertension. American journal of hypertension. 2001 Jun 1;14(S3):178S-85S.
7. . Abalos E, Cuesta C, Carroli G, et al. Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG. 2014;121(Suppl):14–24.
8. Vigil-De Gracia P, Lasso M, Ruiz E, Vega-Malek JC, de Mena FT, López JC; or the HYLA treatment study. Severe hypertension in pregnancy: hydralazine or labetalol. A randomized clinical trial. Eur J ObstetGynecolReprod Biol. 2006 Sep-Oct;128(1-2):157-62.
9. Bangal VB. Effect of Labetalol as an Antihypertensive Agent in Pre-Eclampsia. Annals of Clinical Medicine and Research. 2021;2(1):1-2.
10. Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987–2004. American journal of hypertension 2008;21:521–6.
11. Martin JN, Jr, Thigpen BD, Moore RC, Rose CH, Cushman J, May W. Stroke and severe pre-eclampsia and eclampsia:a paradigm shift focusing on systolic blood pressure. Obstet Gynecol. 2005;105(2):246–254.
12. Berg CJ, Mackay AP, Qin C, Callaghan WM. Overview of maternal morbidity during hospitalization for labor and delivery in the United States: 1993–1997 and 2001–2005. Obstetrics and gynecology 2009;113:1075–81.
13. Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz RL. Pregnancy outcome at age 40 and older. Obstetrics and gynecology 1996;87:917–22.
14. Wang YA, Chughtai AA, Farquhar CM, Pollock W, Lui K, Sullivan EA. Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment. Fertility and sterility 2016;105:920–6.e2.
15. Raheem IA, Saaid R, Omar SZ, Tan PC. Oral nifedipine versus intravenous labetalol for acute blood pressure control in hypertensive emergencies of pregnancy:a randomized trial. BJOG. 2012;119:78–85.
16. Jain M, Gilhotra R, Singh RP, Mittal J. Curry leaf (Murrayakoenigii): A spice with medicinal property. MOJ Biol Med. 2017;2(3):00050.
17. The American College of Obstetricians and Gynecologists. Emergent therapy for acute-onset, severe hypertension with preeclampsia or eclampsia. Committee opinion. 2011 Dec;514:1–4.
18. Swati T, Lila V, Lata R, Prachi G, Pratibha A, Tuhar P. A comparative study of itravenous Labetalol and intravenous Hydrallazine on mean arterial blood pressure changes in pregnant women with hypertensive emergency. Sch J App Med Sci. 2016;4(6F):2256–2259.
19. Nombur LI, Agida ET, Isah AY, Ekele BA. A comparison of Hydrallazine and Labetalol in the management of severe pre eclampsia. J Womens Health Care. 2014;3:6.
20. Wasim T, Agha S, Saeed K, Riaz A. Oral Nifidepine versus IV labetalol in severe preeclampsia: A randomized control trial. Pakistan Journal of Medical Sciences. 2020 Sep;36(6):1147.
21. Gavit Y, Sharma D, Pratibha V, Dixit A comparative study of oral nifedipine and intravenous labetalol in control of acute hypertension in severe pre-eclampsia and eclampsia. IJRCOG. 2018;7(2):12-5.
22. Shi DD, Yang FZ, Zhou L, Wang N. Oral nifedipine vs. intravenous labetalol for treatment of pregnancy-induced severe pre-eclampsia. J Clin Pharm Ther. 2016 Dec;41(6):657-661.
23. Duley L, Meher S, Jones L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev. 2013;2013(7):CD001449.
24. Delgado De Pasquale S, Velarde R, Reyes O, et al. Hydralazine vs labetalol for the treatment of severe hypertensive disorders of pregnancy. A randomized, controlled trial. Pregnancy Hypertens. 2013;4(1):19–22.
25. AnjumanAlam, Zakaria S.M.A. Oral nifedipine or intravenous labetalol for acute blood pressure control in hypertensive emergency in pregnancy:A randomized controlled trial. IJRCOG. 2019;8(5):1921–7.
26. Wasim T, Agha S, Saeed K, Riaz A. Oral Nifidepine versus IV labetalol in severe preeclampsia: A randomized control trial. Pak J Med Sci. 2020;36(6):1147-1152.
27. Sathya Lakshmi B, Dasari P. Oral nifedipine versus intravenous labetalol in hypertensive urgencies and emergencies of pregnancy: a randomized clinical trial. Obstet Med. 2012;5(4):171-5.