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PP166. HELLP syndrome: Challenges for establishing diagnostic criteria
Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Neonatal death occurred in three cases (7.3%), mainly due to extreme preterm delivery. Other outcomes are reported in the following table.
Variable
Mean ± SD or N(%)
Gravidity
2.659 ± 1.769
Parity
1.341 ± 1.575
Maternal age (years)
27.61 ± 7.193
Gestational age at diagnosis
34.73 ± 4.675
34 weeks
26 (63.5)
<34 weeks
15 (36.5)
Birth weight (g) N = 39
2401 ± 1054
<1000
6 (15.3)
1000–2000
8 (20.6)
>2000
25 (64.1)
Corticoid for lung maturation
15 (100)
Single dose
9 (60)
Complete course
6 (40)
Mode of delivery (N = 37) Vaginal delivery
6 (16.2)
Cesarean section
31 (83.8)
Patients admitted to ICU
37 (90.2)
Mean: 2 days (1–5)
ICU: Intensive Care Unit. Conclusion: This is a good example of how has been the approach of preeclamptic women in a big city of Brazil. Our results suggest that a special concern about the moment of referring these patients to tertiary care units should be taken by doctors at first care units.
329
for failing to engage with the proposed question, and 43 articles remained. Twenty seven articles were excluded because of the language, unable in Latin America, letters, case report and articles published prior to 1999. Sixteen original articles were included. Eleven reviews, one prospective study, two cohorts, one retrospective cohort study and a cross. Studies were classified according to degree of recommendation and level of evidence. Results: The term clinical and laboratory markers were varied and their cut-off levels differ among the authors. The appearance of eclampsia, pain in the upper abdomen, nausea and significant proteinuria and other maternal morbidities were more frequent in patients with HELLP syndrome. The levels of lactic dehydrogenase, AST, and uric acid were further elevated in women with HELLP syndrome guarding correlation with the prognosis of the case. There is no consensus for the interpretation of laboratory values that may represent the most widespread occurrence of parameters: hemolytic anemia, elevated liver enzymes and thrombocytopenia. Other morbidities may have clinical signs, symptoms and laboratory abnormalities that mimic the syndrome. Conclusion: There are many questions to establish standard diagnostic criteria for all patients with HELLP syndrome, necessitating studies consistent with significant population numbers to establish the main signs and symptoms and try to reach consensus on the best markers for the diagnosis and its proper indexes cutting.
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.277
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.276
PP166. HELLP syndrome: Challenges for establishing diagnostic criteria K.R. Moraes, L.C. Tavares, R.H. Machado, W. Yoshimoto, C.S. Olmos, M.A. Macedo, V. Augusto, S.F. Toledo, R.G.R. Guidoni, F.L.P. Sousa *, A.B.B. Rodrigues (Obstetrics, UNILUS – Lusíada Foundation/Faculty of Medical Sciences of Santos, Santos, Brazil) Introduction: Preeclampsia is a public health problem which may manifest as pre-eclampsia (hypertension, proteinuria and/or edema) and eclampsia (convulsive crises and rarely coma in pregnant women with previous preeclampsia). But the pathology of hypertensive disease of pregnancy can present different clinical forms. Within that spectrum is HELLP syndrome: hemolysis (H), elevated liver enzymes (EL) and thrombocytopenia (LP). Objectives: To assess the diagnostic criteria in the literature adopted for HELLP syndrome. Methods: A literature review on the Virtual Health Library with the keywords ‘‘HELLP syndrome’’ and ‘‘diagnosis’’ found 674 citations. Six hundred and thirty-four dismissed
PP167. A process evaluation of an innovative implementation strategy of the Dutch guidelines on hypertensive disorders in pregnancy using a computerized decision support system S. Luitjes 1,*, K. Mesri 1, M. Wouters 1, M. van Tulder 2,3, R. Hermens 4 (1 Obstetrics and Gynaecology, Vrije University Medical Centre, Amsterdam, The Netherlands, 2 EMGO+ Institute for Health and Care Research, The Netherlands, 3 Department of Health Sciences, Faculty of Earth & Life Sciences, VU University, Amsterdam, The Netherlands, 4 Scientific Institute for Quality of Health Care (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands) Introduction: Hypertensive disorders in pregnancy remain the leading cause of maternal mortality in the Netherlands. The Dutch Society of Obstetrics and Gynecology (NVOG) has developed evidence-based guidelines on the management of hypertension in pregnancy. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in different hospitals. In the BIG CHANGE trial an innovative implementation strategy of the NVOG guidelines on hypertension using a webbased application (BOS, by Giant Soft, Leeuwarden, The Netherlands) was compared to a common strategy of professional audit and feedback. In this study a process evaluation
Neonatal death occurred in three cases (7.3%), mainly due to extreme preterm delivery. Other outcomes are reported in the following table.
Variable
Mean ± SD or N(%)
Gravidity
2.659 ± 1.769
Parity
1.341 ± 1.575
Maternal age (years)
27.61 ± 7.193
Gestational age at diagnosis
34.73 ± 4.675
34 weeks
26 (63.5)
<34 weeks
15 (36.5)
Birth weight (g) N = 39
2401 ± 1054
<1000
6 (15.3)
1000–2000
8 (20.6)
>2000
25 (64.1)
Corticoid for lung maturation
15 (100)
Single dose
9 (60)
Complete course
6 (40)
Mode of delivery (N = 37) Vaginal delivery
6 (16.2)
Cesarean section
31 (83.8)
Patients admitted to ICU
37 (90.2)
Mean: 2 days (1–5)
ICU: Intensive Care Unit. Conclusion: This is a good example of how has been the approach of preeclamptic women in a big city of Brazil. Our results suggest that a special concern about the moment of referring these patients to tertiary care units should be taken by doctors at first care units.
329
for failing to engage with the proposed question, and 43 articles remained. Twenty seven articles were excluded because of the language, unable in Latin America, letters, case report and articles published prior to 1999. Sixteen original articles were included. Eleven reviews, one prospective study, two cohorts, one retrospective cohort study and a cross. Studies were classified according to degree of recommendation and level of evidence. Results: The term clinical and laboratory markers were varied and their cut-off levels differ among the authors. The appearance of eclampsia, pain in the upper abdomen, nausea and significant proteinuria and other maternal morbidities were more frequent in patients with HELLP syndrome. The levels of lactic dehydrogenase, AST, and uric acid were further elevated in women with HELLP syndrome guarding correlation with the prognosis of the case. There is no consensus for the interpretation of laboratory values that may represent the most widespread occurrence of parameters: hemolytic anemia, elevated liver enzymes and thrombocytopenia. Other morbidities may have clinical signs, symptoms and laboratory abnormalities that mimic the syndrome. Conclusion: There are many questions to establish standard diagnostic criteria for all patients with HELLP syndrome, necessitating studies consistent with significant population numbers to establish the main signs and symptoms and try to reach consensus on the best markers for the diagnosis and its proper indexes cutting.
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.277
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.276
PP166. HELLP syndrome: Challenges for establishing diagnostic criteria K.R. Moraes, L.C. Tavares, R.H. Machado, W. Yoshimoto, C.S. Olmos, M.A. Macedo, V. Augusto, S.F. Toledo, R.G.R. Guidoni, F.L.P. Sousa *, A.B.B. Rodrigues (Obstetrics, UNILUS – Lusíada Foundation/Faculty of Medical Sciences of Santos, Santos, Brazil) Introduction: Preeclampsia is a public health problem which may manifest as pre-eclampsia (hypertension, proteinuria and/or edema) and eclampsia (convulsive crises and rarely coma in pregnant women with previous preeclampsia). But the pathology of hypertensive disease of pregnancy can present different clinical forms. Within that spectrum is HELLP syndrome: hemolysis (H), elevated liver enzymes (EL) and thrombocytopenia (LP). Objectives: To assess the diagnostic criteria in the literature adopted for HELLP syndrome. Methods: A literature review on the Virtual Health Library with the keywords ‘‘HELLP syndrome’’ and ‘‘diagnosis’’ found 674 citations. Six hundred and thirty-four dismissed
PP167. A process evaluation of an innovative implementation strategy of the Dutch guidelines on hypertensive disorders in pregnancy using a computerized decision support system S. Luitjes 1,*, K. Mesri 1, M. Wouters 1, M. van Tulder 2,3, R. Hermens 4 (1 Obstetrics and Gynaecology, Vrije University Medical Centre, Amsterdam, The Netherlands, 2 EMGO+ Institute for Health and Care Research, The Netherlands, 3 Department of Health Sciences, Faculty of Earth & Life Sciences, VU University, Amsterdam, The Netherlands, 4 Scientific Institute for Quality of Health Care (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands) Introduction: Hypertensive disorders in pregnancy remain the leading cause of maternal mortality in the Netherlands. The Dutch Society of Obstetrics and Gynecology (NVOG) has developed evidence-based guidelines on the management of hypertension in pregnancy. Previous studies showed a low adherence rate to other NVOG guidelines and a large variation in usual care in different hospitals. In the BIG CHANGE trial an innovative implementation strategy of the NVOG guidelines on hypertension using a webbased application (BOS, by Giant Soft, Leeuwarden, The Netherlands) was compared to a common strategy of professional audit and feedback. In this study a process evaluation