Glyceryltrinitrat intravenös bei hypertensiven Erkrankungen in der Schwangerschaft - Ein altes Medikament mit neuer Indikation?

Zusammenfassung

Fragestellung: Ist bei schwerer hypertensiver Erkrankung in der Schwangerschaft (SIH) die intravenöse Glyceryltrinitratinfusion (GTN) in Ausnahmesituationen eine Behandlungsalternative? Patienten und Methode: Eine Patientin mit Pfropfgestose in der 27. SSW mit V. a. medikamenten-toxischem Leberschaden durch Dihydralazin und Methyldopa sowie eine Patientin in der 30. SSW mit SIH und vorzeitiger Wehentätigkeit ohne adäquates Ansprechen auf Dihydralazin wurden mit GTN perfusorgesteuert intravenös (0,5 - 4 mg/h) behandelt. Ergebnisse: In beiden Fällen konnte der Blutdruck unter GTN befriedigend gesenkt werden, wobei die uterusrelaxierende Wirkung von GTN in einem Fall zugleich ausgenutzt werden konnte. Schlußfolgerung: Nach unseren Ergebnissen steht mit GTN in begründeten Ausnahmefällen eine wirksame und sicher zu handhabende Behandlungsalternative in der Therapie der schweren SIH zur Verfügung, wenn Dihydralazin nicht oder nicht mehr anwendbar ist.

Abstract

Objective: Nitroglycerin was used successfully in the second-line treatment of severe hypertension in two pregnant patients. Case report: One patient with preexisting hypertension developed severe hypertension at 27 weeks' gestation. Treatment with dihydralazine and methyldopa caused toxic liver damage. Another patient had severe hypertension unresponsive to dihydralazine an also had uterine contractions. Both patients received intravenous nitroglycerin at a rate of 0.5 - 4.0 mg/h over a period of 3 days. Maternal mean blood pressure returned to an almost normal level and uterine contractions ceased. There were no negative effects on mother or fetus. Conclusion: Nitroglycerin may be considered for short-term second-line treatment of severe hypertension in pregnancy.

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