Acute hypertension in Obstetric practice in Delivery Maternty eard.

.  Experience  of prescribing & supervising Nitropruside IV by any of us?? Any member had   experience of using such a potent drug(nitroprusside)   without the permission or physical presence of a physician or intervenist ?? How was the  result??  Occasinals myself and my colleagues  used Nitropruside  by syringe pump in cases of acute HTN in pregancy as an life saving agent in Obstet practice. However, Nitropruside drip should be the third or 4^th choice in controlling HTN if Labtolol /Hydralazine(uncertain availably) be used in acute HTN reporting at ER  prior to  delivery emergency cases .

The dose of Nitropruside  in acute HTN where BP is  say anywhere between 180-210 mm / 120-140 mm and one desperately   is trying  to reduce BP  is 0.25 mcg /Kg/minute . BP should come down by 30 mt to 1 hr to avert in all my observed cases where myself was worried about  cerebral hge/Pontine haemorrhage  . However principle is not to lower the  diast BP < 100 mm diastolic(Pre delivery-to avoid sluggish placental perfusion).

There are four options to control acute HTN presenting at any time in our Depptt. By acute HTN ,I mean . BP is somewhere 180-210-/ 120-150 mm Hg .

Choice  1: I V Bolus LABETOLOL: Boos Labetolol 20/40/80 mg I V by 1 minute  time (bolus) and record BP after 10 minutes. Once in my lifetime I had push  80 mg Labetolol as first bolus on admission labetolol another 40 mg after 10 mts.  Surprisingly by 45 mts BP came down to 150/90.. However most cases will respond favorably with initial bolus of 20 mg/ 40 mg ; Max permitted dose of IV Labet is 220 mg per day.

 Option 2:-The second Drug is Inj Hydralazine: (not readily available).Dose 5 mg bolus to be reputed after 20 minutes, To record BP every 15 mts. Total first hr dose should be < 20 mg per hr.

Option 3:-Third choiced drug in acute severe HTN is Tab Nifedipine (not capsule).  Nicardia –again not retard formulation in acute HTN reporting at ER. Usual dose is  10 mg every 30 mts(not suitable for the case of Dr Archana Maam as she was unable rot swallow and again reminding all of you that Nifedipine can’t be given by  forcibly opening her mouth by sublingual rout are was used 2 decades back. Dictum is no sublingual route  please.

Choice  4: Syringe Pump & Nitropruside: The dose is 0.25 mcg /Kg / mt but 5 mcg /Kg/mt if Bp level is somewhere 220/ 150. After initiating the syringe pump one may seek help of an emergency physician present I house or may consult over phone.

  ICU facility and easy availability of Nitropruside at Obstet Bld(in house):-Fortunately in most Medical, Colleges Septic Wards are vanishing and so also the space for “Eclampsia Room”. Instead such space is utilized as Obstet ICU. In case that ICU in same Bldg is not there then one can seek help of Cardiology ICU nurse to control and titrate the drip. I take this opportunity to thank such ICU sisters posted in ICU to rash into Obstet Deppt on request in about 12 occasions since 186 to 2018 to titrate Nitropruside pump AS PGT s are unfamiliar with this very potent drug Like NorAd drip.