ABSTRACT
Increasing experimental and clinical evidence points to a subset of severe pre-eclamptic
women who are hypoyalemic with a low cardiac index and a high systemic vascular resistance,
and in whom vasodilatory therapy may cause precipitate falls in maternal perfusion
pressure, unless anticipated by prior correction of the hypovolemia. Since there is
a paucity of adequately controlled clinical trials with appropriate definitions of
hypotension or perinatal outcome, the consequences of such episodes for the preterm
fetus are unknown. Epidemiologic evidence, using a logistic regression analysis model,
is reviewed, which points to an association between a hypotensive episode following
a commonly used drug, hydralazine, and a worse perinatal outcome in a study of severely
hypertensive women delivered less than 32 weeks. An estimate of this risk, using the
odds ratio, is 5.97 (95% confidence interval 1.84 to 19.35).
