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Malignant ventricular arrhythmias in eclampsia: a comparison of labetalol with dihydralazine.

Author(s): Bhorat IE, Naidoo DP, Rout CC, Moodley J

Affiliation(s): Department of Obstetrics and Gynecology, University of Natal, Durban, South Africa.

Publication date & source: 1993-04, Am J Obstet Gynecol., 168(4):1292-6.

Publication type: Clinical Trial; Comparative Study ; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

OBJECTIVE: Our aim was to assess the impact of beta-adrenergic blockade during the peripartum period on the previously observed high incidence of ventricular arrhythmias in eclamptic parturients. STUDY DESIGN: An open, randomized comparison of intravenous labetalol versus dihydralazine was conducted in 40 eclamptic subjects in the peripartum period. Cardiac rhythm was assessed by blinded analysis of a 24-hour Holter record by means of the Lown classification of arrhythmias. RESULTS: There was a significantly higher incidence of serious ventricular arrhythmias in patients receiving dihydralazine (81%) than in those receiving labetalol (17%, p < 0.0001). Patients receiving labetalol showed a significant decrease in mean heart rate (p < 0.0001), whereas patients receiving dihydralazine showed a significant increase (p < 0.0001). CONCLUSION: The introduction of beta-adrenergic blockade into peripartum hypertensive management of eclampsia significantly reduced the incidence of dangerous ventricular arrhythmias. Myocardial oxygen supply/demand ratio may be improved by beta-blockade.

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