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The Effect of a Nitric Oxide Donor on Fetal Heart Rate Patterns in Patients With Hypertension

From the Department of Obstetrics and Gynecology, Rambam Medical Center; andFaculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Address reprint requests to: Israel Thaler, MD, Rambam Medical Center, Department of Obstetrics and Gynecology, POB 9602, Haifa 31096, Israel; E-mail: thaler{at}netvision.net.il.

OBJECTIVE: To estimate whether nitric oxide donors can be administered safely to patients with pregnancy-associated hypertension based on computer analysis of antepartum fetal heart rate (FHR) tracings.

METHODS: Thirty-minute recordings of FHR and fetal movements, before (stage I) and after (stage II) sublingual administration of 5 mg of isosorbide dinitrate, a nitric oxide donor, were obtained in 20 women with pregnancy-associated hypertension.

RESULTS: Baseline FHR in stage I did not differ significantly from that in stage II (140.9 ± 2.0 beats per minute and 137.5 ± 2.1 beats per minute, respectively). There were no significant differences between stage I and II in the number (9.67 ± 1.14 versus 9.56 ± 1.07), amplitude (26.14 ± 1.03 versus 24.5 ± 0.85 beats per minute), and duration (36.03 ± 1.46 versus 34.04 ± 1.57 seconds) of heart rate accelerations. During stage II, the number (1.39 ± 0.43) and duration (26.9 ± 1.38 seconds) of heart rate decelerations did not change significantly as compared with stage I (1.67 ± 0.33 and 26.23 ± 1.13 seconds, respectively). However, the amplitude of heart rate decelerations was significantly higher in stage I compared with stage II (-19.36 ± 1.44 versus -14.38 ± 1.55 beats per minute, respectively). There were more fetal body movements during stage II than stage I (12.39 ± 2.8 versus 9.72 ± 2.0), but the difference was not statistically significant.

CONCLUSION: Based on numeric analysis of FHR records, our data suggest that short-acting donors of nitric oxide can be administered safely to patients with pregnancy-associated hypertension.