الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Hypertensive disorders are important contributors to maternal morbidity and mortality, and women diagnosed with a hypertensive disorder of pregnancy are likely to meet criteria for postpartum antihypertensive therapy as well as require several days of postpartum observation.
In addition, women with hypertensive disorders of pregnancy are at increased risk for cesarean delivery, with its attendant need for postoperative pain relief.
Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly cyclooxygenase inhibitors, is known to increase the risk of develop¬ment of hypertension (HTN) in healthy, nonpregnant women as well as to antagonize the effects of some antihy¬pertensive drugs in hypertensive patients receiving treatment after just a few days of NSAID use.
The hypothesized mechanisms for this effect include the NSAID-mediated alteration of aldoste¬rone metabolism, sodium retention, inhibition of prostaglandin-mediated vasodilation, and production of vaso¬active metabolites of arachidonic acid via cytrochrome-P450 induction.
Because of this concern, the American College of Obstetricians and Gynecol¬ogists (ACOG) suggests avoiding the postpartum use of NSAIDs in women diagnosed with preeclampsia who have postpartum hypertension (HTN), though evidence in support of this recommendation is limited. Animal studies are limited to a single investigation in a rat model of preeclampsia, which showed that indomethacin had no effect on blood pressure (BP) while rats were still pregnant. In human beings, the limited data on the influence of NSAIDs on postpartum BP among women with preeclampsia are conflicting.
NSAIDs are ideally suited for postpartum pain control and are still widely used for postpartum and postcesarean delivery pain management in nonhypertensive women because of their effectiveness. They are more effective than acetaminophen to alleviate pain from obstetric perineal injury, and have also been shown to decrease opioid use after cesarean delivery.
This double-blinded, ran¬domized controlled trial was conducted at Ain Shams University Maternity Hospital to generate evidence for or against the use of nonsteroidal anti-in¬flammatory drugs in women with postpartum hypertension (HTN) and evaluate the effect of ibuprofen vs acetaminophen on postpartum BP control among women with preeclampsia with severe features. The study included 150 severe preeclamptic pregnant women. All women were randomly allocated into two equal groups; group A: included 75 women and were given 500 mg acetaminophen and group B: included 75 women and were given 600 mg ibuprofen. They received either acetaminophen 500 mg or ibuprofen 600 mg within 6 hours after delivery for every 6 hours started immediately after delivery and continued for the duration of their postpartum hospitalization (72 hours).
Regarding demographic characteristics; statistical analysis of current study showed that there were no significant differences between women of both groups regarding age, gestational age, and parity, no. of previous miscarriage, and mode of previous delivery or past medical history.
Regarding mode of antepartum and postpartum data; statistical analysis of current study showed that there were no significant differences between women of both groups regarding antepartum and postpartum serum creatinine, ALT, AST, systolic or diastolic blood pressures, mode of current delivery or mode of anesthesia.
Regarding postpartum pain; statistical analysis of current study showed that there were no significant differences between women of both groups regarding 10-cm VAS for postpartum pain and rates of moderate-to-severe pain in the first 24 hours and 24-48 hours postoperatively. The rates of need for extra analgesia and need for opioid analgesia were slightly higher among women of group I “acetaminophen”, yet not to a statistically significant level.
Regarding postpartum blood pressure; statistical analysis of current study showed that there were no significant differences between women of both groups regarding rates of severe systolic or diastolic hypertension up to 48 hours postoperatively.
The limitations of current study were due to COVID 19 pandemic and relatively small sample size.
Conclusion
In women with severe preeclampsia, short term using - up to 48 hours - of NSAIDs as ibuprofen and acetaminophen for postpartum analgesia had no significant effect on maternal blood pressure.
Recommendations
If no other contraindications, NSAIDs as ibuprofen and acetaminophen can be used for post cesarean section analgesia in women with severe preeclampsia up to 48 hours without significant effect on maternal blood pressure, however there was no significant difference between both drugs regarding their analgesic efficacy.
Although reassuring, the available data of current study regarding the safety of postpartum NSAIDs originate from small sized double-blinded, ran¬domized controlled trial, thus the evidence is of very low quality. Therefore, future large-scale RCTs are needed to verify these outcomes, as well as to elucidate the opioid-sparing effects of NSAIDs and ascertain the most appropriate patient population for their administration in order to achieve an optimal balance between efficacy and safety.