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520 Parlodel, severity of pregnancy induced hypertension (PIH) and postpartum hypertension
SPO Abstracts
Volume 16-l l\umbe l I. Pan 2
518
RETINAL SEQUELAE OF SEVERE PREGNANCY INDUCED HYPERTENSION Christine J. Chai*, David F. Lewis, Thomas J. GariteUniversity of California, Irvine and Long Beach Memorial Medical Center Severe pregnancy induced hypertension (SPIH) continues to cause significant maternal morbidity and mortality. Previous ophthalmologic complications have focused on cortical blindness. However, the major ophthalmologic symptom is blurred vision. The clinical significance of this symptom has not been previously established. We reviewed all patients with SPIH whose blurred vision progressed to decreased visual acuity necessitating ophthalmologic consultation. 12 patients were identified over a five year period. 11 of these patients were maternal transports. All 12 of these patients had retinal edema causing significant decreased visual acuity. 3 patients also had retinal detachment, and 1 had retinal artery occlusion . All patients had a positive fluid balance averaging over 2.5 liters . 2 patients had significant and persistent visual sequelae requiring therapy (17%). We feel that this ophthalmologic morbldl\y might be prevented by careful fluid management in these critically ill patients.
519 NEONATAL MANIFESTATIONS OF MATERNAL HELLP SYN DROME. Lucinda J . Dykes, M.D;, Maine Mp.dical Cp.nter, Portland, Maine. Neonates born to mothers with severe hyper tension have bep.n shown to have a significantly higher incidence of growth retardation , thrombocytopenia, leukopenia, neutropenia, and low Apgar scorp.s, but little is known about neonates born to preeclamptic mothers with HELLP syndrome. Al l neonates born to mothers with HELLP syndrome (n= 18) and admittp.d to the NICU over 2 years (1 / 1/88 - 12/3 1/89 ) were compare d to control in fants matched for sex and ge stational age . Neonates born to mothers with HELLP syndrome were smaller at birth (p <.05) and This group had lower 1" Apgar s (p < .05) • also had Significantl y lower total white counts (p < .01), absolute neutrophil counts (p < .0001) and platelet counts (p < • 001) , and higher nucleatp.d red blood cell counts (p < .0001) than matched contro ls. Although thp. incidence of re sp iratory disease, sepsis, or IVH was not increased in HELLP infants, the mortality rat e was signi f icantly hi gher (p < .05) . Further work is needed to compare this group to infant s born to mothers with sevp.re hypertension but without HELLP syndrome.
389
520 PARLODEL, SEVERITY OF PREGNANCY INDUCED HYPERTENSION (PIH) AND POSTPARTUM HYPERTENSION. R. Bhatia, MD,S. Bottoms, MD, D. Watson, MD, P. Blunden, MD', R. Sokol, MD Hutzel Hospital/Wayne State Univ, Detroit, MI Patients with antepartum PIH receiving Parlodel for lactation suppression are at increased risk for the development of postpartum hypertension Any relationship of severity of PIH and the use of Parlodel has not been studied. To investigate this potential relationsip, 40 pairs with PIH (20 with and 20 without the use of Parlodel) were matched by the admission blood pressure l±.10 mm Hg). Patients were considered to have severe PIH if the admission blood pressure was ~ 160/110 mm Hg (10 pairs) . The mean arterial pressures (MAP) and the postpartum drop in MAP were calculated in each matched pair. To evaluate the contributions of severity of PIH and the use of Parlodel to the postpartum drop in MAP, the data were analyzed by paired ANOVA with the following results' F df P Severity of PIH
0.2 1 /22 NS Mild PIH Severe PIH 41 1/ 8 0.01 Our data suggest that only in severe PIH patients using Parlodel for milk suppression was the drop in postpartum MAP was significantly less than control patients (p < 0.01). In patients receiving Partodel, the postpartum MAP was higher by 13 mm Hg in the severe and by 0.3 mm Hg in the mild PIH groups respectively, than in patients not receiving Partodel. In conclusion, the use of parlodel for postpartum lactation suppression should be avoided primarily with severe PIH.
521 FINAPRES:
A NONINVASIVE DEVICE TO MONITOR BLOOD PRESSURE KB Porter. MD, WF O'Brien, MD, V Klefert, MS', RA Knuppel, MD, MPH. UniverSity of South Florida College of MediCine, Tampa, Flori da.
With the development of new deVices obstetrical patients are often not evaluated In preliminary studies. The purpose of our study was to compare the bias and precIsion of the nOntnvaslve FI nap res dl gl tal probe to osclll ometrl c and arterl a 1 record I ngs of blood pressures obtaIned In low and hIgh nsk pregnant wome n The FI napres works on the pr l nc I p1e that photop 1ethysmography can be used to assess blood pressure sInce the cuff IS beIng dnven to equal the artenal press ure throughout the cyc le Thl rty-el ght women WI th pregnancy Induced h yper tens Ion (n=24). chromc hypertension (n=2) , cardIac dI sease (=2), or no ri sk factors except undergQ.1ng epIdural cathe ter placement (n= IO) were Studl ed. 01 fferences Arterl a l-FI nap res SystolIC Arten a 1-01 namap SystolIC Arten a l-Fl napres D,astol,c Arterl a 1-01 namap Diastol,c •
Blood Pressure (x:!: S.D.)
10 81 :!: 16 38' 9 48 :!: 16 98' -0 . 76:!: 76:!:
9.51 8 49'
p = 0 0001
In concluslOn the mean dIfferences a nd s tandard deVIat Ions confIrmed that the Flnapres prOVIded a fairly accura t e assessment of true artenal systolIC pressure and a very accurate measure of dl asto 11 c pressure
Volume 16-l l\umbe l I. Pan 2
518
RETINAL SEQUELAE OF SEVERE PREGNANCY INDUCED HYPERTENSION Christine J. Chai*, David F. Lewis, Thomas J. GariteUniversity of California, Irvine and Long Beach Memorial Medical Center Severe pregnancy induced hypertension (SPIH) continues to cause significant maternal morbidity and mortality. Previous ophthalmologic complications have focused on cortical blindness. However, the major ophthalmologic symptom is blurred vision. The clinical significance of this symptom has not been previously established. We reviewed all patients with SPIH whose blurred vision progressed to decreased visual acuity necessitating ophthalmologic consultation. 12 patients were identified over a five year period. 11 of these patients were maternal transports. All 12 of these patients had retinal edema causing significant decreased visual acuity. 3 patients also had retinal detachment, and 1 had retinal artery occlusion . All patients had a positive fluid balance averaging over 2.5 liters . 2 patients had significant and persistent visual sequelae requiring therapy (17%). We feel that this ophthalmologic morbldl\y might be prevented by careful fluid management in these critically ill patients.
519 NEONATAL MANIFESTATIONS OF MATERNAL HELLP SYN DROME. Lucinda J . Dykes, M.D;, Maine Mp.dical Cp.nter, Portland, Maine. Neonates born to mothers with severe hyper tension have bep.n shown to have a significantly higher incidence of growth retardation , thrombocytopenia, leukopenia, neutropenia, and low Apgar scorp.s, but little is known about neonates born to preeclamptic mothers with HELLP syndrome. Al l neonates born to mothers with HELLP syndrome (n= 18) and admittp.d to the NICU over 2 years (1 / 1/88 - 12/3 1/89 ) were compare d to control in fants matched for sex and ge stational age . Neonates born to mothers with HELLP syndrome were smaller at birth (p <.05) and This group had lower 1" Apgar s (p < .05) • also had Significantl y lower total white counts (p < .01), absolute neutrophil counts (p < .0001) and platelet counts (p < • 001) , and higher nucleatp.d red blood cell counts (p < .0001) than matched contro ls. Although thp. incidence of re sp iratory disease, sepsis, or IVH was not increased in HELLP infants, the mortality rat e was signi f icantly hi gher (p < .05) . Further work is needed to compare this group to infant s born to mothers with sevp.re hypertension but without HELLP syndrome.
389
520 PARLODEL, SEVERITY OF PREGNANCY INDUCED HYPERTENSION (PIH) AND POSTPARTUM HYPERTENSION. R. Bhatia, MD,S. Bottoms, MD, D. Watson, MD, P. Blunden, MD', R. Sokol, MD Hutzel Hospital/Wayne State Univ, Detroit, MI Patients with antepartum PIH receiving Parlodel for lactation suppression are at increased risk for the development of postpartum hypertension Any relationship of severity of PIH and the use of Parlodel has not been studied. To investigate this potential relationsip, 40 pairs with PIH (20 with and 20 without the use of Parlodel) were matched by the admission blood pressure l±.10 mm Hg). Patients were considered to have severe PIH if the admission blood pressure was ~ 160/110 mm Hg (10 pairs) . The mean arterial pressures (MAP) and the postpartum drop in MAP were calculated in each matched pair. To evaluate the contributions of severity of PIH and the use of Parlodel to the postpartum drop in MAP, the data were analyzed by paired ANOVA with the following results' F df P Severity of PIH
0.2 1 /22 NS Mild PIH Severe PIH 41 1/ 8 0.01 Our data suggest that only in severe PIH patients using Parlodel for milk suppression was the drop in postpartum MAP was significantly less than control patients (p < 0.01). In patients receiving Partodel, the postpartum MAP was higher by 13 mm Hg in the severe and by 0.3 mm Hg in the mild PIH groups respectively, than in patients not receiving Partodel. In conclusion, the use of parlodel for postpartum lactation suppression should be avoided primarily with severe PIH.
521 FINAPRES:
A NONINVASIVE DEVICE TO MONITOR BLOOD PRESSURE KB Porter. MD, WF O'Brien, MD, V Klefert, MS', RA Knuppel, MD, MPH. UniverSity of South Florida College of MediCine, Tampa, Flori da.
With the development of new deVices obstetrical patients are often not evaluated In preliminary studies. The purpose of our study was to compare the bias and precIsion of the nOntnvaslve FI nap res dl gl tal probe to osclll ometrl c and arterl a 1 record I ngs of blood pressures obtaIned In low and hIgh nsk pregnant wome n The FI napres works on the pr l nc I p1e that photop 1ethysmography can be used to assess blood pressure sInce the cuff IS beIng dnven to equal the artenal press ure throughout the cyc le Thl rty-el ght women WI th pregnancy Induced h yper tens Ion (n=24). chromc hypertension (n=2) , cardIac dI sease (=2), or no ri sk factors except undergQ.1ng epIdural cathe ter placement (n= IO) were Studl ed. 01 fferences Arterl a l-FI nap res SystolIC Arten a 1-01 namap SystolIC Arten a l-Fl napres D,astol,c Arterl a 1-01 namap Diastol,c •
Blood Pressure (x:!: S.D.)
10 81 :!: 16 38' 9 48 :!: 16 98' -0 . 76:!: 76:!:
9.51 8 49'
p = 0 0001
In concluslOn the mean dIfferences a nd s tandard deVIat Ions confIrmed that the Flnapres prOVIded a fairly accura t e assessment of true artenal systolIC pressure and a very accurate measure of dl asto 11 c pressure