HTN assciated with preclampsia

[IllinoisCCEMT-P]

Hello thanks for reading. I have a question. We have recently started doing ground critical care transports and was wondering for HTN associated with preclampsia which drug have you had the best results with? Labetolol or Hydrolazine. We carry both but I was wondering if you had any horror stories with one or both. Or any good outcomes with one and swear by it. Thanks

[CEG]

I have always used only labetalol. Both are pregnancy category C but it seems that no matter where rI have been no one would give anything but labetalol for pregnant patients and no one was willing to give lasix. It seems to generally have some effect. We are never that interested in treating the HTN where I work because it is only a symptom of the pre-e, the patient still has to be delivered regardless of the BP.

[HappyNurse2005, RN]

I've seen both used. Though, I agree with the above, that the BP is a symtpom of the problem, not the cause.

[CEG]

Sorry, didn't mean lasix... just noticed my error.

[Medic/Nurse, BSN, RN]

I think labetolol is a better choice as there are less side effects - profound hypotension is rare and HR stays controlled, and ICP is decreased. It is important to note that mag loading and infusion can be important in pre-eclamsia management (not just in contractions of pre-term labor - where we think of mag) as the mag has cerebral vasodilation and plays an active role in preventing seizures - these are complex patients and the medicine is rarely straightforward. This is also a HIGH RISK area for liability - so, extra care and caution can be protective of the patient and you.

The key for me - and since I do not do a lot of high risk maternity, I defer to those more experienced that I am (meaning the OB's - get 'em involved EARLY and maintain a way to contact they IMMEDIATELY). I am good enough at what I do to recognize that others are better than I am in certain situations.

Although we have to know our practice and be very good at what we do - never forget that you have a medical director that extends you the opportunity to essentially practice medicine (to some degree) under his license. OB is one of the few areas when I insist on MD direct contact.

The problem with the pre-eclampsia set is that the ONLY cure is to not be pregnant anymore - and that makes decisions tough. Some develop it early when fetal mortality is highest and some can hang till late 34+ weeks and early delivery can still have happy outcomes for mom and babe.

Do the best for you and the patients. I think both have roles in the "toolbox" and each patient can be different. Not sure I helped much.

Good Luck and Congrats we need more motivated and experienced critical care medics!

Practice SAFE!!

[ldcmw1]

Where I work to use Labetalol IV they have to be hooked up to a cardiac monitor. Not the case with hydralazine. Yes, the hypertension is a symptom of the problem but it still needs to be treated! Do you want your patient to stroke out. I'm guessing as an EMT your patient does have an IV. I prefer hydralazine myself. It increases uterine perfusion. Be careful to use labetalol on a patient with asthma it is contraindicated. Lastly, you don't want to drop the blood pressure too much or the fetus won't like that.