Use of sodium nitroprusside in complications of gestational hypertension.

Abstract

Sodium nitroprusside is a potent and ultrafast-acting antihypertensive agent. Limited clinical experience and uncertainty about toxicity have restricted its use in obstetrics. The authors have used nitroprusside concomitantly with hemodynamic monitoring in 4 obstetric patients with severe pregnancy-induced hypertension unresponsive to conventional therapy. The patients with acute congestive heart failure and pulmonary edema responded rapidly and dramatically to nitroprusside. No signs of fetal distress associated with lowering of the arterial pressure were observed, and significant cyanide levels were not detected in a fetal cord blood sample. Nitroprusside should be reserved for refractory hypertensive emergencies in pregnancy. Hemodynamic monitoring is required for adjusting nitroprusside administration and fluid balance. In short-term usage, the authors' experience suggests that maternal and fetal toxicity may not be serious concerns.