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01.aog.0000148270.53433.66
01.aog.0000148270.53433.66
OBJECTIVE: This investigation was undertaken to estimate Acute or chronic hypertensive disorders of pregnancy
whether a brief postpartum course of furosemide for pa- affect a substantial population of pregnant patients in the
tients with preeclampsia benefits recovery and shortens United States each year, all of whom must evidence
hospitalization by enhancing diuresis, lessening severe hy- suitable and sufficient recovery postpartum to meet cri-
pertension, and reducing the need for antihypertensive teria for safe hospital discharge. Although considerable
therapy.
attention has been directed to antepartum and intrapar-
METHODS: Two hundred sixty-four patients with pre- tum management issues regarding patients with pre-
eclampsia were enrolled. After spontaneous onset of post- eclampsia and related hypertensive disorders of preg-
partum diuresis and discontinuation of intravenous mag- nancy, such as minimizing the development of eclampsia
nesium sulfate, patients were randomly assigned to receive
using magnesium sulfate, much less research on the
either no therapy or 20 mg oral furosemide daily for 5 days
puerperium has been undertaken to illuminate the phys-
with oral potassium supplementation. Patient outcomes
iology and relevant interventions for appropriate post-
were compared between treatment groups with regard to
classification of hypertensive disease.
partum management of this heterogeneous group of
patients.
RESULTS: Only postpartum patients with severe pre-
Puerperal normalization of patients with the spectrum
eclampsia (n ⴝ 70) who received furosemide compared
of preeclampsia proceeds variably over time, possibly
with controls had significantly lower systolic blood pres-
sure by postpartum day 2 (142 ⴞ 13 mm Hg compared
exaggerating or impeding the normal extent of blood
with 153 ⴞ 19 mm Hg, P < .004) and required less antihy- volume shifts that follow the cessation of gestation in a
pertensive therapy during hospitalization (14% compared vascular system that is injured, vasospastic, or inflexible.
with 26%, P ⴝ .371) and at discharge (6% compared with Although complete recovery from severe preeclampsia
26%, P ⴝ .045). No benefit was shown for patients with can require an extended period of time,1– 4 most patients
mild preeclampsia (n ⴝ 169) or superimposed preeclamp- who develop complications do this within the first 2
sia (n ⴝ 25). Neither length of hospitalization nor fre- weeks after delivery.5 These include severe hyperten-
quency of delayed postpartum complications was posi- sion requiring medication or major fluid shifts that cause
tively affected by the intervention. cerebral or pulmonary edema. It would be desirable to
CONCLUSION: Brief postpartum furosemide therapy for pa- minimize or eliminate these altogether with use of a
tients with severe preeclampsia seems to enhance recovery low-cost medical intervention such as furosemide to
by normalizing blood pressure more rapidly and reducing accelerate recovery and shorten hospitalization without
the need for antihypertensive therapy. Shortening of hos- adverse maternal or perinatal consequences.
pitalization and reduction of delayed postpartum compli- This investigation was undertaken in patients with
cations were not benefitted. (Obstet Gynecol 2005;105: preeclampsia to assess the efficacy of a short 5-day post-
29 –33. © 2005 by The American College of Obstetricians partum course of orally administered furosemide to en-
and Gynecologists.) hance diuresis and lower blood pressure, thereby reduc-
LEVEL OF EVIDENCE: I ing the need to initiate antihypertensive agents with their
attendant cost, potential side effects, and the need to hold
the patient longer in the hospital to assure the attainment
From the Departments of Obstetrics and Gynecology and Preventive Medicine of blood pressure control. A secondary goal was to
(Biostatistics), University of Mississippi Medical Center, Jackson, Mississippi. shorten hospitalization and thereby reduce health care
Supported in part by the Vicksburg Hospital Medical Foundation, Vicksburg, cost. Although the size of the study is not adequate to
Mississippi. properly assess whether this intervention lessens periph-