Drugs used in the

management of Pre-
eclampsia
By Venance Ntengo,
Intern pharmacist-MZRH
Introduction
• Pre-eclampsia is one of the hypertensive disorders
in pregnant women.

• Definition:
• Pre-eclampsia is a pregnancy-specific condition
usually occurring after 20 weeks of gestation
characterized by hypertension, proteinuria and
edema.
Pathophysiology of Pre-eclampsia
Progressive placental and maternal endothelia cell dysfunction,
increased platelet aggregation and loss of arterial vasoregulation

Loss of elasticity of the blood vessels especially the capacitance vessels

Increased blood pressure  Hypertension

Damage of the glomerular vessels

Loss of proteins through pores in the glomerulus  Proteinuria

Reduced oncotic pressure to hold water within the vessels

Escape of unstrained water to the surrounding tissues  Edema

Clinical features of Pre-eclampsia
• Headache
• Blurred vision
• Loss of consciousness
• Nausea and vomiting
• Epigastric pain

NB: When women with Pre-eclampsia exhibit

seizures, the term eclampsia is used.
Categorization of Pre-eclampsia
• Pre-eclampsia is generally categorized into:
• Mild and
• Severe Pre-eclampsia
• Mild pre-eclampsia
• Blood pressure is 140/90 mmHg to 160/110 mmHg on
two measurements taken 4 hours apart.
• Proteinuria is between 300mg and 5g in a 24 hours urine
specimen.
• Severe pre-eclampsia
• Blood pressure rises to 160/110 mmHg or higher on two
measurements taken 4 hours apart
• Proteinuria is 5g or higher in a 24 hours specimen
Management modalities
• Mild Pre-eclampsia:
• Oral antihypertensives: Methyldopa, Nifedipine or
Labetalol
• Severe Pre-eclampsia:
• Injectable antihypertensive: Hydralazine, Labetalol
• Magnesium sulfate prophylaxis to prevent progression
to Eclampsia

• NB: The definitive treatment of Pre-eclampsia is

delivery
Some fast-moving drugs used to
manage Pre-eclampsia at Meta
i. Methyldopa
• A centrally acting alpha receptors agonist
• Mechanism of action: Agonizes alpha receptors in the
CNS which decreases sympathetic outflow and thus
decrease blood pressure.
• Has longest and best safety record of all
antihypertensive agents during pregnancy.
• Pregnancy category B
• Adverse effects: Dizziness and sedation
• Dosage: 500 mg 8 hourly
ii. Nifedipine
• A calcium channel blocker
• Mechanism of action: Reduces calcium influx into the
vascular smooth muscles, inhibiting their contractions
and thus causing vasodilation.
• Pregnancy category C.
• Adverse effects: Dizziness, headache and constipation.
• Dosage: 20mg 12 hourly
iii. Hydralazine
• A vasodilator
• Mechanism of action: Directly dilates arterial smooth
muscles hence vasodilating the arteries
• Pregnancy category C
• Adverse effects: Nausea, vomiting, tachycardia, flushing,
headache and tremors.
• Dosage: 5mg IV or 10mg IM
iv. Magnesium sulfate
• A drug of choice to prevent seizures
• Mechanisms of action: Act as a calcium antagonists and
a vascular smooth muscles relaxer.
• Loading dose: 4-6 g in NS over 10-15 minutes
• Maintenance dose: 2-3 g/ hour in NS over 24 hours
• Magnesium toxicity: respiratory depression, cardiac
arrest
• Antidote: 10% Calcium gluconate 10 mL IV over 10
minutes
Thank you for listening