- Email: [email protected]
eclampsia as hellp syndrome
S108
SPO Abstracts
J a n u m y 1997 A m J O b s t e t Gynecol
600 GRAMS: C U T P O I N T O N THE CUSP OF PER/NATAL VIABILITY IN PREGNANCIES WITH HELLP SYNDROME. M.H. Ascz~relli, R.W. Ma~r K.G. Perry, fl:, P.G. Blake, x E.F. Magann, .]iN. Martin, Jr. Dept. of Ob/Gyn, University of Mississippi, Jackson, MS. OBJECTIVE: To profile the maternal parameters associated with perinatal-neonatal nmrtality and survival in very preterm pregnancies delivered with worsening Class 1 or 2 HELLP syndrome. STUDY DESIGN: Data for all pregnancies ~4th Class 1 or 2 HELLP syndrome and birthweights -> 500 and < 900 gm was analyzed via assignment of all pregnancies (n = 69) to one of four groups by birthweight ranges: Group t, --> 500 < 600 gin; Group 2, -> 600 - < 700 gin; Group 3, --> 700 - < 800 gin; and Group 4, --> 800 - < 90ll gin. RESULTS: This patient population was mostly African American (n = 58, 84%), nulliparous (n 37, 54%) and affected with class 1 HELLP syndrome (n = 39, 57%). Selected outcomes are presented by group assignment:
I
Group 1 ] (n = 17) ] Adm-Del - hr Adm-Del <24 hr Ante-Steroid St > 48 hr: Stow Smw-Vag Sur,,-CS Yeri Mort Rate Neo-Inf Survival
1-189 13 (76%) 8 (47%) 1/3 (33%) 0/7 (0%) 3/10 (30%) 824:1000 3/17 (18%)
Group2 (n = 13)
(~roup 3 (n = 21)
Group 4 (n = 18)
3-456 9 (69%) 3 (23%) 2/2 (100%) 1/2 (50%) 10/11 (91%) 154:1000 11/13 (85%)
2-75 18 (86%) 7 (33%) 3/3 (100%) 1/2 (50%) 16/19 (84%) 190:1000 17/21 (81%)
3-135 13 (72%) 4 (22%) 4/4 (100%) 0 (0%) 15/18 (83%) 167:1000 15/18 (84%)
Adm, admission; Del, delively; Ante, antenatal; Surv, survival; Vag, vaginal; CS, cesarean; Neo-Inf, neoltatal infant; Peri, perinatal; Mort, nortality CONCLUSIONS: Although successful perinatal outcome is a possibility in the birthweight range of 500-600 gin, exceeding this weight range accords the progeny with significantly increased chances of survival. Interventions to safely postpone delivery if possible are urost likely to make a difference if at least a 600 gin birthweight can be achieved. Maintenance of maternal cortieosteroid therapy > 48 hours prior to cesarean delivery, appem-s to offer the highest chance of a successful perinatal outcome.
359
BETI'ER MATERNAL OUTCOMES ARE ACHIEVED USING DEXAMETHASONE THERAPY FOR POSTPARTUM HELLP SYNDROME.
f N . Martin, [r., R. H4 Martin, K.G. Perry,Jr., P~G. Blake,~ L Robinette, S A. Moore.-" Dept. of Ob/Gyu, University of Mississippi, Jackson, MS. OBJECTIVE: To determine if the routine initiation of dexamethasone (DEX) in patients with postpartum Class 1 or 2 HELLP syndrome produces specific and general therapeutic benefits. STUDY DESIGN: The puerperal courses of 43 mothers who initially received DEX after delivery were compared to 240 other patients with Class 1 or 2 HELLP syndrome who received no eorticosteroids whatsoever during the peripartmn course. Treated patients received DEX 10 m g 1V at 12-hour intervals until disease remission was noted at which time up to two additional 5-rag IV doses at 12-hour intervals were given. RESULTS: The two patient groups were similar in regard to nrode of delivery, gestational age, HELLP severity, parity, and fi-equency of eclampsia. Compared to controls, postpartmn DEX-treated patients had significantly higher (p < 0.05) admissim~ mean arterial blood pressure, serum uric acid, and 3-4 + proteinuria. Yet DEX was associated with a more rapid normalization of platelets and LDH by postpartum day 2, the need for transfusion and respiratory therapy was reduced, inf~ectious/bleeding too> bidity was lessened, and hospitalization was shortened. PP DEX (n = 43) PP day 1 platelets PP day 2 platelets Transfused blood Transiused plasma Respirator,/" therapy Infection/bleeding Delivery-discharge (d)
86,000 -+ 30,000 98,000 + 34,000 2 (4.7%) 0 1 (2.3%) 6 (14%) 4.3 -+ 1.6
No DEX (n - 240) 84,000 83,000 73 26 13 113 6
-+ 38,000 + 37,000 (30.5%) (10.8%) (5.4%) (47%) + 3.4
p NS .016 <.001 .024 <.05 <.05 .002
PP, postpartmn; d, days CONCLUSIONS: DEX for the patient with postpartum HELLP syndrome shorteus the disease course, accelerates recovery, nlininlizes morbidity, and significantly decreases the need for other interwmtive therapy.
360
MATERNAL WEIGHT AND OBESITY WITH SEVERE PRI~ECLAMPSIA/ ECLAMPSIA AS HELLP SYNDROME. R.W. Martin. P.G. Blake,~ L Robi nette,~ A. Moore,"J.3~ Martin, t : Dept. of Ob/Gyn, University of Mississippi, Jackson, MS. OBJECTIVE: Severe maternal obesity" is a risk factm" for severe preeelampsia. Does a similar relationship exist between maternal weight and HELLP syndrome? STUDY DESIGN: Maternal weight was recorded for 436 of 460 consecutive patients managed with Class 1 or 2 HELLP syndrome. Patients were assigned to one of fore" groups: Group 1, <150 lbs; Group 2, 150 - <200 Ibs.; Group 3, 200 - -<250 Ibs; and Group 4, >250 Ibs. Selected maternaiperinatal data for these pregnancies were analyzed in relation to weight group. RESULTS: There were no significant dittierences among groups in relation to indices of HELLP syndrome severity, race, delivery mode, gestational age, or perinatal outcome. Significantly associated with increasing maternal weight were age, parity, mean arterial pressure (MAP), and systolic blood pressures (SBP), chronic hypertension, and admission to delivery intmwal. Inverse associations included nulliparity, eclampsia, indicated red cell transfusion (pRBC), and delivery to discharge interval:
Maternal age (yrs) Parig Chronic H T N A d m i t MAP P e a k AP-SBP P e a k PP-SBP Eclampsia T r a n s f u s e d pRBCs
<.001 <.05 <.001 <.05 <.001 .001 .005 .001
Group 1 ( n = 143)
Group 2 ( n = 198)
21 42 3 116 164 164 26 55
23 68 19 118 177 165 16 50
-+ 5 (29%) (2%) + 15 • 24 _+ 18 (18%) (39%)
+ 6 (34%) (10%) -+ t6 -+ 23 -+ 26 (8%) (25%)
Croup 3 I Group 4 ( n = 67) I ( n = 28) 25 33 15 120 182 176 3 10
-+ 5 (49%) (22%) -+ 16 • 22 _+ 19 (5%) (15%)
28 13 10 126 188 176 2 4
-- 7 (46%) (36%) _+ 16 + 21 _+ 17 (1%) (14%)
H T N , hypertension; AP-SBP, a n t e p a r t u m SBP; PP-SBP, p o s t p a r t u m SBP CONCLUSIONS: ~Mthough age, pariS, MAP and SBP appear to be significantly associated with increasing maternal weight in this patient population, timing and severity of the underlying pathophysiology of HELLP syndrome appears unrelated to maternal size. Interestingly, eclampsia occurs much less frequently in the heavier gravida with HELLP syndrome.
361
EXPANDED IMPLEMENTATION OF DEXAMETHASONE FOR HELLP SYNDROME PREGNANCIES IMPROVES MATERNAL-PERINATAL OUTCOMES, K.G. Pen~,. [r., R.W. Martin, E.F. Magann, P.G. Blake, x L. Rotnnette,~J.N. Martin, ft. Dept. of Ob/Gyn, Univ. of Miss., Jackson, MS. OBJECTIVE: After demonstrating maternal-fetal benefit with antepartuna or postpartum dexamethasone (DEX) administration for HELLP syndrome pregnancies treated during 1992-1993, routine utilization of either betamethasone (BMZ) for fetal fimg inamration (FLM) a n d / o r DEX for HELLP syndrmne antepartmn a n d / o r postpartum was encouraged during 1994 and 1995. We postulate that aggressive steroid utilization considerably improved maternal and perinatal outcomes compared to 1988-1991 when corticosteroids were used sparingly. STUDY DESIGN: All pregnancies with Class 1 and 2 HELLP syndrome managed during 1988-1991 (Group 1, n - 169) were compared to those managed during 1994-1995 (Group 2, n - 64). Stlbgroups include use of DEX or BMZ fbr FLM or DEX for HELLP syndrome before (ANTE-DEX), after (POST-DEX), or around (BOTH-DEX) delivery:
Group 1 (1988-1991) DEX for FLM BMZ for FLM A_NTE-DEX POST-DEX BOTH-DEX
23 (14%) 7 (4%) 0 0 0
Croup 2 (1994-1995)
11 11 49 15
0 (17%) (17%) (77%) (22%)
RESULTS: Overall steroid utilization increased from 18% in Group 1 to 85% in Group 2 (p < .001) while maternal disease severity" was reduced as reflected by platelet nadir (X, 67,000/~L vs 57,000/p.L; p = .01D. Fewer patients deteriorated to Class I HELLP (p/atelets <50,000/~L: 30% in Gronp 2 vs 44% in Group 1; p = .07). Significantly" fewer patients in Group 2 received blood products (only 5 patients) vs 56 in Group 1 (p < .05). Maternal respiratory support measures, infectious/wound morbidity" (I9% vs 46%; p < .05). bleeding (3% vs 11%; p < .05) and hyaline nmmbrann . disease declined (~8% vs 48%; p < .05) significantly. CONCLUSIONS: Expanded, aggressive eorticosteroid utilization in HELLP syndrome pregnancies was associated with significantly improved maternal-perinatal outcmnes.
SPO Abstracts
J a n u m y 1997 A m J O b s t e t Gynecol
600 GRAMS: C U T P O I N T O N THE CUSP OF PER/NATAL VIABILITY IN PREGNANCIES WITH HELLP SYNDROME. M.H. Ascz~relli, R.W. Ma~r K.G. Perry, fl:, P.G. Blake, x E.F. Magann, .]iN. Martin, Jr. Dept. of Ob/Gyn, University of Mississippi, Jackson, MS. OBJECTIVE: To profile the maternal parameters associated with perinatal-neonatal nmrtality and survival in very preterm pregnancies delivered with worsening Class 1 or 2 HELLP syndrome. STUDY DESIGN: Data for all pregnancies ~4th Class 1 or 2 HELLP syndrome and birthweights -> 500 and < 900 gm was analyzed via assignment of all pregnancies (n = 69) to one of four groups by birthweight ranges: Group t, --> 500 < 600 gin; Group 2, -> 600 - < 700 gin; Group 3, --> 700 - < 800 gin; and Group 4, --> 800 - < 90ll gin. RESULTS: This patient population was mostly African American (n = 58, 84%), nulliparous (n 37, 54%) and affected with class 1 HELLP syndrome (n = 39, 57%). Selected outcomes are presented by group assignment:
I
Group 1 ] (n = 17) ] Adm-Del - hr Adm-Del <24 hr Ante-Steroid St > 48 hr: Stow Smw-Vag Sur,,-CS Yeri Mort Rate Neo-Inf Survival
1-189 13 (76%) 8 (47%) 1/3 (33%) 0/7 (0%) 3/10 (30%) 824:1000 3/17 (18%)
Group2 (n = 13)
(~roup 3 (n = 21)
Group 4 (n = 18)
3-456 9 (69%) 3 (23%) 2/2 (100%) 1/2 (50%) 10/11 (91%) 154:1000 11/13 (85%)
2-75 18 (86%) 7 (33%) 3/3 (100%) 1/2 (50%) 16/19 (84%) 190:1000 17/21 (81%)
3-135 13 (72%) 4 (22%) 4/4 (100%) 0 (0%) 15/18 (83%) 167:1000 15/18 (84%)
Adm, admission; Del, delively; Ante, antenatal; Surv, survival; Vag, vaginal; CS, cesarean; Neo-Inf, neoltatal infant; Peri, perinatal; Mort, nortality CONCLUSIONS: Although successful perinatal outcome is a possibility in the birthweight range of 500-600 gin, exceeding this weight range accords the progeny with significantly increased chances of survival. Interventions to safely postpone delivery if possible are urost likely to make a difference if at least a 600 gin birthweight can be achieved. Maintenance of maternal cortieosteroid therapy > 48 hours prior to cesarean delivery, appem-s to offer the highest chance of a successful perinatal outcome.
359
BETI'ER MATERNAL OUTCOMES ARE ACHIEVED USING DEXAMETHASONE THERAPY FOR POSTPARTUM HELLP SYNDROME.
f N . Martin, [r., R. H4 Martin, K.G. Perry,Jr., P~G. Blake,~ L Robinette, S A. Moore.-" Dept. of Ob/Gyu, University of Mississippi, Jackson, MS. OBJECTIVE: To determine if the routine initiation of dexamethasone (DEX) in patients with postpartum Class 1 or 2 HELLP syndrome produces specific and general therapeutic benefits. STUDY DESIGN: The puerperal courses of 43 mothers who initially received DEX after delivery were compared to 240 other patients with Class 1 or 2 HELLP syndrome who received no eorticosteroids whatsoever during the peripartmn course. Treated patients received DEX 10 m g 1V at 12-hour intervals until disease remission was noted at which time up to two additional 5-rag IV doses at 12-hour intervals were given. RESULTS: The two patient groups were similar in regard to nrode of delivery, gestational age, HELLP severity, parity, and fi-equency of eclampsia. Compared to controls, postpartmn DEX-treated patients had significantly higher (p < 0.05) admissim~ mean arterial blood pressure, serum uric acid, and 3-4 + proteinuria. Yet DEX was associated with a more rapid normalization of platelets and LDH by postpartum day 2, the need for transfusion and respiratory therapy was reduced, inf~ectious/bleeding too> bidity was lessened, and hospitalization was shortened. PP DEX (n = 43) PP day 1 platelets PP day 2 platelets Transfused blood Transiused plasma Respirator,/" therapy Infection/bleeding Delivery-discharge (d)
86,000 -+ 30,000 98,000 + 34,000 2 (4.7%) 0 1 (2.3%) 6 (14%) 4.3 -+ 1.6
No DEX (n - 240) 84,000 83,000 73 26 13 113 6
-+ 38,000 + 37,000 (30.5%) (10.8%) (5.4%) (47%) + 3.4
p NS .016 <.001 .024 <.05 <.05 .002
PP, postpartmn; d, days CONCLUSIONS: DEX for the patient with postpartum HELLP syndrome shorteus the disease course, accelerates recovery, nlininlizes morbidity, and significantly decreases the need for other interwmtive therapy.
360
MATERNAL WEIGHT AND OBESITY WITH SEVERE PRI~ECLAMPSIA/ ECLAMPSIA AS HELLP SYNDROME. R.W. Martin. P.G. Blake,~ L Robi nette,~ A. Moore,"J.3~ Martin, t : Dept. of Ob/Gyn, University of Mississippi, Jackson, MS. OBJECTIVE: Severe maternal obesity" is a risk factm" for severe preeelampsia. Does a similar relationship exist between maternal weight and HELLP syndrome? STUDY DESIGN: Maternal weight was recorded for 436 of 460 consecutive patients managed with Class 1 or 2 HELLP syndrome. Patients were assigned to one of fore" groups: Group 1, <150 lbs; Group 2, 150 - <200 Ibs.; Group 3, 200 - -<250 Ibs; and Group 4, >250 Ibs. Selected maternaiperinatal data for these pregnancies were analyzed in relation to weight group. RESULTS: There were no significant dittierences among groups in relation to indices of HELLP syndrome severity, race, delivery mode, gestational age, or perinatal outcome. Significantly associated with increasing maternal weight were age, parity, mean arterial pressure (MAP), and systolic blood pressures (SBP), chronic hypertension, and admission to delivery intmwal. Inverse associations included nulliparity, eclampsia, indicated red cell transfusion (pRBC), and delivery to discharge interval:
Maternal age (yrs) Parig Chronic H T N A d m i t MAP P e a k AP-SBP P e a k PP-SBP Eclampsia T r a n s f u s e d pRBCs
<.001 <.05 <.001 <.05 <.001 .001 .005 .001
Group 1 ( n = 143)
Group 2 ( n = 198)
21 42 3 116 164 164 26 55
23 68 19 118 177 165 16 50
-+ 5 (29%) (2%) + 15 • 24 _+ 18 (18%) (39%)
+ 6 (34%) (10%) -+ t6 -+ 23 -+ 26 (8%) (25%)
Croup 3 I Group 4 ( n = 67) I ( n = 28) 25 33 15 120 182 176 3 10
-+ 5 (49%) (22%) -+ 16 • 22 _+ 19 (5%) (15%)
28 13 10 126 188 176 2 4
-- 7 (46%) (36%) _+ 16 + 21 _+ 17 (1%) (14%)
H T N , hypertension; AP-SBP, a n t e p a r t u m SBP; PP-SBP, p o s t p a r t u m SBP CONCLUSIONS: ~Mthough age, pariS, MAP and SBP appear to be significantly associated with increasing maternal weight in this patient population, timing and severity of the underlying pathophysiology of HELLP syndrome appears unrelated to maternal size. Interestingly, eclampsia occurs much less frequently in the heavier gravida with HELLP syndrome.
361
EXPANDED IMPLEMENTATION OF DEXAMETHASONE FOR HELLP SYNDROME PREGNANCIES IMPROVES MATERNAL-PERINATAL OUTCOMES, K.G. Pen~,. [r., R.W. Martin, E.F. Magann, P.G. Blake, x L. Rotnnette,~J.N. Martin, ft. Dept. of Ob/Gyn, Univ. of Miss., Jackson, MS. OBJECTIVE: After demonstrating maternal-fetal benefit with antepartuna or postpartum dexamethasone (DEX) administration for HELLP syndrome pregnancies treated during 1992-1993, routine utilization of either betamethasone (BMZ) for fetal fimg inamration (FLM) a n d / o r DEX for HELLP syndrmne antepartmn a n d / o r postpartum was encouraged during 1994 and 1995. We postulate that aggressive steroid utilization considerably improved maternal and perinatal outcomes compared to 1988-1991 when corticosteroids were used sparingly. STUDY DESIGN: All pregnancies with Class 1 and 2 HELLP syndrome managed during 1988-1991 (Group 1, n - 169) were compared to those managed during 1994-1995 (Group 2, n - 64). Stlbgroups include use of DEX or BMZ fbr FLM or DEX for HELLP syndrome before (ANTE-DEX), after (POST-DEX), or around (BOTH-DEX) delivery:
Group 1 (1988-1991) DEX for FLM BMZ for FLM A_NTE-DEX POST-DEX BOTH-DEX
23 (14%) 7 (4%) 0 0 0
Croup 2 (1994-1995)
11 11 49 15
0 (17%) (17%) (77%) (22%)
RESULTS: Overall steroid utilization increased from 18% in Group 1 to 85% in Group 2 (p < .001) while maternal disease severity" was reduced as reflected by platelet nadir (X, 67,000/~L vs 57,000/p.L; p = .01D. Fewer patients deteriorated to Class I HELLP (p/atelets <50,000/~L: 30% in Gronp 2 vs 44% in Group 1; p = .07). Significantly" fewer patients in Group 2 received blood products (only 5 patients) vs 56 in Group 1 (p < .05). Maternal respiratory support measures, infectious/wound morbidity" (I9% vs 46%; p < .05). bleeding (3% vs 11%; p < .05) and hyaline nmmbrann . disease declined (~8% vs 48%; p < .05) significantly. CONCLUSIONS: Expanded, aggressive eorticosteroid utilization in HELLP syndrome pregnancies was associated with significantly improved maternal-perinatal outcmnes.