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What is In preterm labour which drug has Neuro-protective role? and explain in detail?
Ans. (a) MgSO4 Ref: Williams Obstetrics 25th Ed; Page No-730* To prevent convulsions; Administer IV MgSO4 and Continue IV MgSO4 for 24 hours after delivery.* Always avoid Nifedipine and b-blockers, because they cause severe maternal complication.Antihypertensive Drug Therapy Issues* Discontinue medications: This may be done in patients with mild-to-moderate HTN caused by the normal decrease in BP that occurs in pregnancy. Pharmacologic treatment in patients with diastolic BP <90mmHg or systolic BP <140mmHg does not improve either maternal or fetal outcome.* Maintain medications: It may be necessary in the case of patients with severe HTN. The drug of choice is methyl-dopa because less teratogenicity. Labetalol may be acceptable as alternatives. b-blocking agents side effects are intrauterine growth retardation (IUGR).* "Never use" medications: Angiotensin-converting enzyme inhibitors are mostly contraindicate in pregnancy, due to it is associated with some side effects; such as fetal hypocalvaria, renal failure, oligohydramnios, and death. Diuretics are contraindicated during pregnancy due to possible adverse fetal effects which are associated with the plasma volume reduction.* BP target range: Decreases of BP to normal valve in pregnancy may jeopardize Uteroplacental blood flow. Maintain diastolic values between 90 and 100mmHg.Management* Conservative outpatient management is appropriate with uncomplicated mild-to-moderate chronic HTN.# Stop drug therapy: Try to discontinuation of antihypertensive agents. Follow guideline outlined.# Serial sonograms and antenatal testing is appropriate after 30 weeks' gestation to monitor for increased risk of IUGR.# For early identification of superimposed preeclampsia; Serial BP and urine protein assessment are needed.# If the cervix is favorable; Induce labor at 39 weeks* Aggressive prompt delivery is indicated for chronic HTN with superimposed preeclampsia at any gestational age.# To prevent convulsions; Administer IV MgSO4 and Continue IV MgSO4 for 24 hours after delivery.# Try to keep diastolic BP between 90 and 100mmHg with IV hydralazine and/or labetalol.# If mother and fetus are stable; Attempt vaginal delivery with IV oxytocin infusion.