- Email: [email protected]
[236-POS]
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 5 (2015) 53–156
improved referral of hypertensive women, and a reduced proportion of women who had never previously had BP measured in pregnancy (median gestation 35 weeks) (25.1–16.9%, OR 0.58, p = 0.001, CI 0.42–0.79). Conclusions: Equipping low-skilled community healthcare providers (cHCPs) with novel BP devices is feasible and widely accepted, resulting in a significant rise in mean diastolic BP and improved antenatal BP screening. Phase two will evaluate the adapted device, which incorporates a traffic light early warning system that alerts cHCPs to both hypertension and shock, improving the detection of compromise from obstetric haemorrhage and sepsis, as well as preeclampsia. A multi-center institutional-level prospective study in South Africa will evaluate the value of the thresholds used for the traffic light early warning system to predict adverse outcome, prior to a large community cluster RCT to evaluate the introduction of the devices at a communitylevel on maternal and perinatal mortality and morbidity. Disclosures: N.L. Hezelgrave: None. H.L. Nathan: None. K.E. Duhig: None. P.T. Seed: None. A.H. Shennan: None. doi:10.1016/j.preghy.2014.10.241
[236-POS] Patient perspectives on screening/diagnostic tests, clinical trials, and expectant management for preeclampsia Caryn J. Rogers a, Jenny Hewison b, Eleni Tsigas a (a Preeclampsia Foundation, Melbourne, FL, USA, b Leeds Institute of Health Sciences, Leeds, United Kingdom) Objectives: Preeclampsia and conditions such as HELLP complicate 5% of first pregnancies and are a leading cause of prematurity, maternal morbidity, and maternal and neonatal mortality and are linked to chronic disease in both mother and child. The only treatment is delivery regardless of gestational age, the only therapy is LDA (thought to be of slight benefit to the very high-risk subset of the population), and no screening test exists. To evaluate attitudes, beliefs, and values about screening/diagnostic tests, as well as risk tolerance for participation in clinical trials and approaches to expectant management, the Preeclampsia Foundation conducted a pilot online survey of patient perspectives around these issues of testing and care. Methods: Women with and without complicated pregnancy histories were recruited from the Preeclampsia Foundation’s patient network and asked to recruit other individuals with normal histories. They were invited to respond to an online survey via Zoomerang/Survey Monkey and to provide further comment on their views. Framework analysis of written answers was conducted and statistical analysis (chi-square) of questions was performed. Main themes were detected and classified. Results: Regardless of pregnancy history a clear majority of women indicated they would value both screening and diagnostic tests and would be willing to participate in trials. Women with a complicated history were much more likely to endorse testing (p < .0001). Answers diverged on expectant management questions.
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Conclusions: There is strong support for screening and/or diagnostic tests for preeclampsia and substantial willingness to participate in clinical trials. Disclosures: C.J. Rogers: None. J. Hewison: None. E. Tsigas: None. doi:10.1016/j.preghy.2014.10.242
[237-POS] Postpartum eclampsia – A late presentation to keep in mind Sara Nascimento, Rui Gomes, Teresa Matos, Isabel Santos, Fernanda Matos (Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal) Objectives: Presentation of two cases of late postpartum eclampsia that took place at our hospital, one month apart. Eclampsia is defined as generalized seizures, in the setting of preeclampsia, without other neurologic conditions. With an incidence of 1:2.000 deliveries in developed countries, it occurs in 2% of women with severe preeclampsia and in 0.5% of those with non-severe preeclampsia. Although it may occur from gestation to puerperium, it is estimated that only 5–17% of cases take place after 48 h postpartum. While eclampsia is a clinical diagnosis, most cases present with reversible posterior leukoencephalopathy syndrome (RPLS) findings on MRI. Methods: Review of literature and consultation of clinical files. Results: CASE 1 – A 28-year-old female, G2P0, underwent cesarean delivery, at 38 weeks’ gestation, in the setting of preeclampsia and abnormal nonstress test. On day 6 postpartum, she experienced sudden frontooccipital headache, after which she had three generalized tonic–clonic seizures. On admission, she was postictal and hypertensive (170/ 120 mmHg), proteinuria 4+, normal CT scan and EEG. MRI revealed lesions compatible with PRLS. She was admitted to the ICU and treated with magnesium sulfate, valproate and antihypertensive medication, with no further seizures and gradual normalization of blood pressure. CASE 2 – A 31-year-old female, G5P3, with gestational hypertension, underwent vaginal delivery at 40 weeks’ gestation. Since day 2 postpartum she complained of a mild headache. On day 4 she developed blurred vision followed by generalized tonic–clonic seizure. At admission to the ICU, BP was 168/ 110 mmHg. CT and EEG were normal. MRI revealed RPLS. She underwent therapy with magnesium sulfate, valproate and antihypertensive therapy, with no additional seizures and stabilization of blood pressure. Conclusions: Prompt exclusion of other causes of seizures, especially in late presentations, combined with early diagnosis and treatment, are central to avoid morbidity and mortality associated with eclampsia. Disclosures: S. Nascimento: None. R. Gomes: None. T. Matos: None. I. Santos: None. F. Matos: None. doi:10.1016/j.preghy.2014.10.243
improved referral of hypertensive women, and a reduced proportion of women who had never previously had BP measured in pregnancy (median gestation 35 weeks) (25.1–16.9%, OR 0.58, p = 0.001, CI 0.42–0.79). Conclusions: Equipping low-skilled community healthcare providers (cHCPs) with novel BP devices is feasible and widely accepted, resulting in a significant rise in mean diastolic BP and improved antenatal BP screening. Phase two will evaluate the adapted device, which incorporates a traffic light early warning system that alerts cHCPs to both hypertension and shock, improving the detection of compromise from obstetric haemorrhage and sepsis, as well as preeclampsia. A multi-center institutional-level prospective study in South Africa will evaluate the value of the thresholds used for the traffic light early warning system to predict adverse outcome, prior to a large community cluster RCT to evaluate the introduction of the devices at a communitylevel on maternal and perinatal mortality and morbidity. Disclosures: N.L. Hezelgrave: None. H.L. Nathan: None. K.E. Duhig: None. P.T. Seed: None. A.H. Shennan: None. doi:10.1016/j.preghy.2014.10.241
[236-POS] Patient perspectives on screening/diagnostic tests, clinical trials, and expectant management for preeclampsia Caryn J. Rogers a, Jenny Hewison b, Eleni Tsigas a (a Preeclampsia Foundation, Melbourne, FL, USA, b Leeds Institute of Health Sciences, Leeds, United Kingdom) Objectives: Preeclampsia and conditions such as HELLP complicate 5% of first pregnancies and are a leading cause of prematurity, maternal morbidity, and maternal and neonatal mortality and are linked to chronic disease in both mother and child. The only treatment is delivery regardless of gestational age, the only therapy is LDA (thought to be of slight benefit to the very high-risk subset of the population), and no screening test exists. To evaluate attitudes, beliefs, and values about screening/diagnostic tests, as well as risk tolerance for participation in clinical trials and approaches to expectant management, the Preeclampsia Foundation conducted a pilot online survey of patient perspectives around these issues of testing and care. Methods: Women with and without complicated pregnancy histories were recruited from the Preeclampsia Foundation’s patient network and asked to recruit other individuals with normal histories. They were invited to respond to an online survey via Zoomerang/Survey Monkey and to provide further comment on their views. Framework analysis of written answers was conducted and statistical analysis (chi-square) of questions was performed. Main themes were detected and classified. Results: Regardless of pregnancy history a clear majority of women indicated they would value both screening and diagnostic tests and would be willing to participate in trials. Women with a complicated history were much more likely to endorse testing (p < .0001). Answers diverged on expectant management questions.
119
Conclusions: There is strong support for screening and/or diagnostic tests for preeclampsia and substantial willingness to participate in clinical trials. Disclosures: C.J. Rogers: None. J. Hewison: None. E. Tsigas: None. doi:10.1016/j.preghy.2014.10.242
[237-POS] Postpartum eclampsia – A late presentation to keep in mind Sara Nascimento, Rui Gomes, Teresa Matos, Isabel Santos, Fernanda Matos (Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal) Objectives: Presentation of two cases of late postpartum eclampsia that took place at our hospital, one month apart. Eclampsia is defined as generalized seizures, in the setting of preeclampsia, without other neurologic conditions. With an incidence of 1:2.000 deliveries in developed countries, it occurs in 2% of women with severe preeclampsia and in 0.5% of those with non-severe preeclampsia. Although it may occur from gestation to puerperium, it is estimated that only 5–17% of cases take place after 48 h postpartum. While eclampsia is a clinical diagnosis, most cases present with reversible posterior leukoencephalopathy syndrome (RPLS) findings on MRI. Methods: Review of literature and consultation of clinical files. Results: CASE 1 – A 28-year-old female, G2P0, underwent cesarean delivery, at 38 weeks’ gestation, in the setting of preeclampsia and abnormal nonstress test. On day 6 postpartum, she experienced sudden frontooccipital headache, after which she had three generalized tonic–clonic seizures. On admission, she was postictal and hypertensive (170/ 120 mmHg), proteinuria 4+, normal CT scan and EEG. MRI revealed lesions compatible with PRLS. She was admitted to the ICU and treated with magnesium sulfate, valproate and antihypertensive medication, with no further seizures and gradual normalization of blood pressure. CASE 2 – A 31-year-old female, G5P3, with gestational hypertension, underwent vaginal delivery at 40 weeks’ gestation. Since day 2 postpartum she complained of a mild headache. On day 4 she developed blurred vision followed by generalized tonic–clonic seizure. At admission to the ICU, BP was 168/ 110 mmHg. CT and EEG were normal. MRI revealed RPLS. She underwent therapy with magnesium sulfate, valproate and antihypertensive therapy, with no additional seizures and stabilization of blood pressure. Conclusions: Prompt exclusion of other causes of seizures, especially in late presentations, combined with early diagnosis and treatment, are central to avoid morbidity and mortality associated with eclampsia. Disclosures: S. Nascimento: None. R. Gomes: None. T. Matos: None. I. Santos: None. F. Matos: None. doi:10.1016/j.preghy.2014.10.243