440 SPO Abstracts

634 NIPEDIPIME IN 'DIE Sl!XXlU)-LID 'l'RD'DII!R'l' C8 SIM!m: PRE-I!XUMPSIA RI!mCZS 'DIE 1ItDJrfl' OF PRO'l'EINORIA Rgmpinj ~~ Tranquilli AL~ Valensise H; Garzetti GG~ Institute of Obstetrics & Gynecology, University of Ancona, Ancona, Italy

Nifedipine was assessed as a second­line treatment in 59 severe preeclamptic patients resistant to previous labetalol or methyl-dopa treatment. Nifedipine was added at a dose of 40-60 rrg/day. Blood pressure was controlled and became stable at ~ 90 mmHg diastolic within 48 hours, in 55 patients, allowing to prolong pregnancy (mean 12 days, range 3-45). The canbing tion of nifedipine and I abetalol reduced the amount of proteinuria by ~ 25% in 15 patients. Nifedipine should be included in the treatment of severe pre-eclampsia and seems to protect against the evolution of proteinuria.

636 NISOLDIPINE: PRELIMINARY RESULTS USING A NEW ORALLY ADMINISTERED CALCIUM ANTAGONIST IN THE TREATMENT OF SEVERE POSTPARTUM PREGNANCY INDUCED HYPERTENSION (PIH). Michael ~.x Dept. OB/GYN, Groote Schwr Hospital, University of Cape Town, South Africa.

Calciun antagonists are frequently used to manage severe PIH. This study was designed to assess the cl inical use of nisoldipine, 8 new, oral, long acting dihydropyridine, in

severe postpartLIII PIH. MATERIALS AJID IETNOOS: Nisoldipine (Bayer) was given orally (2Omg, eight hourly) to 12 patients with severe postpartLIII PIH (MAP>126 nmHg: >3+ proteinuria). BLood pressure was continuously monitored using an arterial line. Continuous and intermittent 12 lead ECG monitoring was undertaken. Data analysis was with 1-way ANOVA(p<D.05 was significant) RESULTS: Systolic (p<O.01) and diastol ic (p<0.01) blood pressure fell within 30 minutes of initiation of therapy. Significantly reduced blood pressure was maintained with successive doses (q 8 hrs) for the 24 hr study period. There were no 5 i gnl f i cant changes in the heart rate or ECG. There

were no adverse reactions despite the high dosage. COIICLUSIOllS: Nisoldipine rapidly, effectively and safely reduces blood pressure in severe postpartLIII PI H. The potent i a l advantages of this oral calciLIII antagonist should stimulate further controlled investigation.

January 1992 Am.J Obstet Gynecol

637 MANAGEMENT AND OUTCOME OF SEVERE PRE­ECLAMPSIA IN 209 PRETERM PREGNANCIES. J2hrLL ~, Edward J. Wo~, Luanna Lettieri, Dennis Scribnerx, Winston A. Campbell, Anthony M. Vintzileos, University of Connecticut Heahh Center, Farmington, CT

In 1978. Zuspan stated "severe forms of preeciampsia are preventable and should never occur, but once present they should yield a zero maternal mortality rate and a fetal salvage of greater than 90 percent." We undertook this retrospective study of severe preterm preeclampsia over 10 years (1980 - 1989) to assess whether Zuspan's goals are achievable in a preterm population. All charts with a diagnosis of preeclampsia were reviewed. Severe preeclampsia was diagnosed in 209 preterm patients (21-36 weeks) based on the following criteria: BP~160/11 0 (75%), cerebral symptoms (34%), epigastric pain (22%). severe proteinuria (63%), oliguria (1 %). elevated liver enzymes (29%), elevated creatinine (28%), thrombocytopenia (29%), or intrauterine growth retardation (27%). Mean (±.SD) maternal age 26.3 (±5.9)yrs; 71% were nulliparous, 81 % were white, 88% had singleton gestations, mean gestational age was 31.9 wks(±3.0); and 89% were maternal transports. Management consisted of maternal stabilization and prompt delivery, either via oxytocin induction or cesarean section. IV MgS04 was used in 97% of cases. The cesarean section rate was 83%. The mean number of antepartum and postpartum days in the hosp~al were 1.9 and 5.7 respectively; 87% of patients were discharged :>.7 days of delivery. Only 5 patients (2.5%) were discharged with significant morbidity (1 cortical blindness, 2 Bell's palsies. 1 aphasia and 1 blurred vision); all resolved spontaneously. Of 238 infants, 23 % were SGA with mean birthweight of ± 1661 grams; and 93% were discharged alive. Our data suggest that with aggressive management (i.e. delivery), routine use of magnesium su~ate and the liberal use of cesarean section. Zuspan's goals of zero maternal mortality and greater than 90% fetal salvage rates are obtainable, even in preterm severe preeclamptics.

638 ENDOTHELIN-l SERUM LEVELS IN NORMAL AND PREECLAMPTIC PREGNANCIES. C. Croom. MDx, T. Nolan, MDx, L.Devoe.MD. B.Lightfoot.MSx, R.Caruana.MD.x.Dept OBGYN and Nephrology. Med Coli Of Georgia,A ugusta,Georgia

Endothelin-l (ET!) is a potent vasoconstrictor; its seru m levels rise in response to endothelial cell damage. We studied S normal women before pregnancy and during all trimesters and labor to determine the course of ET! levels. We studied 18 additional normal third trimester women before and during labor,8 term preeclamptic(PE) patients before and during labor,and 21 third trimester PE patients in active labor. Serum ET I was determined by RIA. In normal pregnancy. mean ET I levels rose significantly from O.S pg/mJ( I st trimester) to l.l pg/ml and 1.7 pg/ml (third trimester and labor. respectively). Mean ET! levels of PE patients were significantly higher than those of normal patients before labor (1.9 pg/ml vs. 1.2 pg/ml. p=.04) and during labor(3.S pg/ml vs 1.6 pg/ml. p = .006 ).Mean ET I levels in PE did not change significantly with labor(p=.07). The gradual increase in ET! with gestational age and the differences in PE and normal patients are consistent with earlier reports. As the presence of labor and PE both lead to significant increases in ET1, the potential value of ET I for discriminating PE from normal patients would be greatest before labor begins.