Controlled Trial of Chlorothiazide in Treatment of Early Pre-eclampsia

Abstract

MEDICALOURL 7391960) and a central effect (Gillespie et alc., 1962) may play some part. Agar et al. (1958) discussed the underlying theories of pre-eclamptic hypertension production in view of mecamylamine and the ganglion-blocking hypotensive agents being ineffectual in controlling this condition. Recently, Senior et al. (1963) have suggested that 5-hydroxytryptamine (serotonin) may have some role in the production of toxaemia of pregnancy and that antagonists of this substance may be of value in treatment. It is of interest that methyldopa interferes with the formation of serotonin in the body (Oates et al., 1960). SummaryMethyldopa and the chlorothiazide diuretics have been used in 15 patients with severe pre-eclamptic toxaemia. All but one showed a marked and satisfactory fall in blood-pressure, a diminution in proteinuria, and improvement in well-being.The foetus died early in treatment in three patients. All three had severe toxaemia occurring early in the third trimester and showed blood ureas above normal-one of them had the unsuccessful blood-pressure response. The other patients were able to continue with the pregnancies and all were delivered of healthy normal babies except one baby who died of an obstetric cause.The dose of methyldopa was relatively small and the only complication was a drug rash, but other drugs were being given at the same time. However, the number of patients was small and other side-effects may occur. No deterioration has been noted in following the condition of these patients.We should like to thank Mr. Alan Brews for permission to publish his cases. Gillespie, L., Oates, J. A., Crout, J. R., and Sjoerdsma, A. (1962).Circulation, 25, 281.Hamilton, M., and Kopelman, H. (1963). Brit. med. 7.,1, 151. Landesman, R., Ollstein, R. N., and Quinton, K. J. (1959 Pre-eclampsia remains a common complication of pregnancy in this country. Although the foetal wastage appears to be slightly less now than ten years ago, the figures from the National Birthday Trust Perinatal Mortality Survey show that in pregnancies resulting in stillbirth or neonatal death there is still a raised incidence of pre-eclampsia (D. G. Bonham, personal communication, 1963). It is also one of the three most common features of the history where the mother has died ; 18% of maternal deaths are associated with pre-eclampsia (Ministry of Health, 1963).In spite of the importance of the condition the cause remains obscure, and treatment, although relatively successful, is still largely empirical. Hypotensive drugs may have value if given early in pregnancy, but this treatment is possible only for those women who show early hypertension. In cases of non-toxaemic hypertension reserpine seems to have a place but does not reduce foetal loss (Landesman and Ollstein, 1958). In true preeclampsia hypotensive drugs can only be given late and the results are disappointing. A large number of clinicians still rely on prescribing a sedative and advising bed rest, and of these two methods rest in bed is the least empirical. It is kno...

Management of hypertension in pregnancy

“…1 13 – 16 The drugs used most commonly were methyldopa (two trials) and β blockers (eight), particularly labetalol (5/8). Treatment aimed for a diastolic blood pressure less than 90 mm Hg.…”

Diuretics

“…For many years, these conditions were treated with the administration of thiazide diuretics (MENZIES 1964;FINNERTY and BEPKO 1966). The former involves the development of hypertension, edema and proteinuria in patients who have reached the 20th week of gestation.…”

Significance of platelet antibodies in neonatal thrombocytopenic purpura affecting a pair of siblings

“…Menzies (1964) has already referred to the first of these two children in his paper on a 'Controlled trial of chlorothiazide in treatment of early pre-eclampsia'. The serum of the second of these two children and of the mother were examined for possible presence of platelet antibodies, Received for publication 23 December 1964. but such tests were not performed during or after the first pregnancy.…”