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T15.1 Left ventricular systolic and diastolic function and structure in women with untreated preeclampsia
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State of the Art Lectures, Plenary Presentations and Oral Communications / Pregnancy Hypertension 1, Supplement 1 (2010) S1–S41
them were concurrent eclampsia and HELLP syndrome. We analyzed the characteristics (age, gestational weeks, death rate of maternal, the need for mechanical ventilation, the rate for ICU admittion, GCS, CT or MRI, hemotransfusions and so on) of the 17 patients and contrasted with the eclampsia without HELLP syndrome. Fisher exact test and χ2 test were used to test categorical variables. Results: There were 17 patients admitted concurrent eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of concurrent eclampsia and HELLP syndrome was 21.8%. The maternal death rate was 35.3% (6/17) in concurrent eclampsia and HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (P<0.05). There were more patients admitted to ICU and more patients need mechanical ventilation in concurrent eclampsia and HELLP syndrome (13/17 VS 20/59, 9/17 VS 14/59, P<188;0.05), also more patients with GCS≤8 in concurrent eclampsia and HELLP syndrome when admitted (P<0.05), compared to the eclampsia without HELLP syndrome. Nine patients had performed computed tomography scan (CT) or magnetic resonance imaging (MRI) and five (5/9) of them showed cerebral hemorrhage in concurrent eclampsia and HELLP syndrome group, while only 14 patients performed CT or MRI in eclampsia without HELLP syndrome and 3 of them showed cerebral hemorrhage. Conclusion: The incidence of concurrent eclampsia and HELLP syndrome was not rare, and also the maternal mortality rate was really high. It should be warning that the obstetrician should take great attention for these women, and consider life support treatment for them if necessarily.
T14.5 HELLP syndrome: does postpartum dexamethasone improve maternal outcome? Jacobus du Plessis 1 , Jan Van Soest 2 , Gina Joubert 3 . 1 RWH, Melbourne, Australia; 2 Department of O&G, 3 Department of Biostatistics, University of Free State, Bloemfontein, South Africa Objective: To determine if postpartum dexamethasone improves the maternal outcome in patients with HELLP syndrome Methods: A randomized, controlled trial was performed on 68 patients with HELLP syndrome. Patients were randomized for either dexamethasone or no dexamethasone in the postpartum period. Primary outcome measures were length of hospital stay, biochemical improvement in liverand platelet function, intensive care admissions, maternal complications. All patients were followed-up until discharge from hospital. Results: A total of 38 patients received dexamethasone and 30 received no dexamethasone. Twenty three patients had terminations for non-viable fetuses and/or intra-uterine deaths. All patients had haptoglobin-levels of less than 23mg/dl, confirming hemolysis. There were no differences in the outcome between the two groups. Hospital stay and biochemical recovery were the same in both groups. Maternal morbidity and mortality were equal in the two groups. Conclusion: The findings of this study fail to support the use of postpartum dexamethasone in patients with HELLP syndrome.
T14.6 Antioxidant supplementation for prevention of preeclampsia in low-antioxidant status of pregnant women Yuditiya Purwosunu 1 , Noroyono Wibowo 1 , Akihiko Sekizawa 2 , Antonio Farina 3 . 1 Department of Obstetrics and Gynecology, University of Indonesia, Cipto Mangunkusumo National Hospital, Indonesia; 2 Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan; 3 Department of Histology and Embryology Division of Prenatal Medicine, University of Bologna, Bologna, Italy Objective: To study whether antioxidant supplementation (vitamin C and E) will reduce the incidence of preeclampsia among early gestation patients with low-antioxidat status. Methods: A randomized, placebo-controlled, double-blind clinical trial was conducted at University of Indonesia. Women between 8 and 12 weeks of gestation and have low antioxidant status were randomly assigned to daily treatment with vitamin C (1,000mg) and vitamin E (400 IU) or placebo. Analysis was adjusted for gestation age and other confounding factors. Results: Outcome data for 329 of 356 randomly assigned patients revealed no significant reduction in the rate of severe preeclampsia. Univariable risk of severe preeclampsia is 6.8% and 16.5% in supplementation and placebo group consecutively. However there was significant lower incident of mild preeclampsia in supplementation group compared with those of placebo with odd ratio 0.372 (0.178-0.775) p-value=0.008. There were no
differences in mean gestational age at delivery, birth weight, apgar score at 1 min. Conclusion: Supplementation of antioxidant was associated with a trend towards a lower incidence of mild preeclampsia.
T15.1 Left ventricular systolic and diastolic function and structure in women with untreated preeclampsia Alicia Dennis 1 , Julian Castro 2 , Scott Simmons 3 , Caroline Carr 4 , Michael Permezel 3 , Colin Royse 5 . 1 Mercy Hospital for Women Heidelberg & Royal Women’s Hospital, Parkville & The University of Melbourne, Australia; 2 St Vincents Hospital Fitzroy, Australia; 3 Mercy Hospital for Women Heidelberg & The University of Melbourne, Australia; 4 Mercy Hospital for Women Heidelberg, Australia; 5 The Royal Melbourne Hosptial & The University of Melbourne, Australia Background and aim: Preeclampsia is a major cause of maternal morbidity and mortality worldwide [1]. Studies of the underlying cardiac function in women with untreated preeclampsia have produced conflicting results however an understanding of cardiac function is needed to optimally treat these critically unwell women. The aim of this study was to determine left ventricular (LV) systolic function, diastolic function and LV mass using transthoracic echocardiography (TTE) in women with untreated preeclampsia. Method: Our previous study [2] determined the sample size and after institutional ethics approval and informed consent, forty women with untreated preeclampsia and forty gestationally matched healthy women were enrolled. After resting for a minimum of five minutes, heart rate (HR) and blood pressure (BP) were obtained and each woman underwent a standardised TTE examination [2]. Results: See Table 1. Table 1
Age (yr) Gestation (wks) BMI (kg/m2 ) MAP (mmHg) Cardiac output (ml/min) HR (BPM) SV (ml) SVR (dyne · cm/sec5 ) LVEDA (cm2 ) FAC (%) FS (%) Septal e velocity (cm/s) Mitral valve E/ septal e LV mass (g)
Healthy pregnant women (control), n=40
Women with untreated preeclampsia, n=40
P value
31.5±3.9 36.0±4.5 27.8±4.1 80.8±8.3 4109±595 77.8±9.6 53.2±7.9 1612.5±315.4 16.6±2.7 57.1±9.2 34.8±1.2 11.5±2.3 6.7±1.3 130±21
30.6±5.2 36.3±4.2 32.4±6.6 110.8±5.1 4789±1419 80.8±12.7 58.9±12.8 2015.7±624.7 16.6±2.6 64.5±9.3 40.9±7.6 8.7±2.3 10.4±2.4 189±40.1
0.35 0.76 <0.01 <0.01 <0.01 0.44 0.04 0.01 0.95 <0.01 <0.01 <0.01 <0.01 <0.01
Mean ± SD, LVEDA = left ventricular end diastolic area, FAC = fractional area change, FS = fractional shortening.
Conclusions: Women with untreated preeclampsia demonstrate increased cardiac output due to an increase in stroke volume, increased inotropy and significant diastolic changes. These findings support a hypothesis that preeclampsia impairs diastolic function and concurrently increases systolic function and inotropy. Reference(s) [1] Lewis, G. CEMACH 2003-2005. London; 2007. [2] Dennis A et al IJOA 2010 doi:10.1016/j.ijoa.2009.06.007
T15.2 Maternal cardiac function in severe preterm preeclampsia Karen Melchiorre 1 , George Sutherland 2 , Ingrid Watt-Coote 1 , Marco Liberati 3 , Basky Thilaganathan 4 , Aigul Baltabaeva 5 . 1 Fetal Maternal Medicine Unit, St George’s Hospital, University of London, London, UK; 2 Department of Cardiology and Cardiothoracic Surgery, St Georges Hospital, University of London, London, UK; 3 Department of Obstetrics and Gynecology University of Chieti, Chieti, Italy; 4 Fetal Maternal Medicine Unit St George’s Hospital, University of London, London, UK; 5 Department of Cardiology and Cardiothoracic Surgery, St George’s Hospital, University of London, London, United Kingdom, UK Introduction: Preeclampsia (PE) is a disease associated with significant
State of the Art Lectures, Plenary Presentations and Oral Communications / Pregnancy Hypertension 1, Supplement 1 (2010) S1–S41
them were concurrent eclampsia and HELLP syndrome. We analyzed the characteristics (age, gestational weeks, death rate of maternal, the need for mechanical ventilation, the rate for ICU admittion, GCS, CT or MRI, hemotransfusions and so on) of the 17 patients and contrasted with the eclampsia without HELLP syndrome. Fisher exact test and χ2 test were used to test categorical variables. Results: There were 17 patients admitted concurrent eclampsia and HELLP syndrome, and 59 patients admitted eclampsia without HELLP syndrome. The incidence of concurrent eclampsia and HELLP syndrome was 21.8%. The maternal death rate was 35.3% (6/17) in concurrent eclampsia and HELLP syndrome patients, and significantly higher than the rate in eclampsia without HELLP syndrome group (P<0.05). There were more patients admitted to ICU and more patients need mechanical ventilation in concurrent eclampsia and HELLP syndrome (13/17 VS 20/59, 9/17 VS 14/59, P<188;0.05), also more patients with GCS≤8 in concurrent eclampsia and HELLP syndrome when admitted (P<0.05), compared to the eclampsia without HELLP syndrome. Nine patients had performed computed tomography scan (CT) or magnetic resonance imaging (MRI) and five (5/9) of them showed cerebral hemorrhage in concurrent eclampsia and HELLP syndrome group, while only 14 patients performed CT or MRI in eclampsia without HELLP syndrome and 3 of them showed cerebral hemorrhage. Conclusion: The incidence of concurrent eclampsia and HELLP syndrome was not rare, and also the maternal mortality rate was really high. It should be warning that the obstetrician should take great attention for these women, and consider life support treatment for them if necessarily.
T14.5 HELLP syndrome: does postpartum dexamethasone improve maternal outcome? Jacobus du Plessis 1 , Jan Van Soest 2 , Gina Joubert 3 . 1 RWH, Melbourne, Australia; 2 Department of O&G, 3 Department of Biostatistics, University of Free State, Bloemfontein, South Africa Objective: To determine if postpartum dexamethasone improves the maternal outcome in patients with HELLP syndrome Methods: A randomized, controlled trial was performed on 68 patients with HELLP syndrome. Patients were randomized for either dexamethasone or no dexamethasone in the postpartum period. Primary outcome measures were length of hospital stay, biochemical improvement in liverand platelet function, intensive care admissions, maternal complications. All patients were followed-up until discharge from hospital. Results: A total of 38 patients received dexamethasone and 30 received no dexamethasone. Twenty three patients had terminations for non-viable fetuses and/or intra-uterine deaths. All patients had haptoglobin-levels of less than 23mg/dl, confirming hemolysis. There were no differences in the outcome between the two groups. Hospital stay and biochemical recovery were the same in both groups. Maternal morbidity and mortality were equal in the two groups. Conclusion: The findings of this study fail to support the use of postpartum dexamethasone in patients with HELLP syndrome.
T14.6 Antioxidant supplementation for prevention of preeclampsia in low-antioxidant status of pregnant women Yuditiya Purwosunu 1 , Noroyono Wibowo 1 , Akihiko Sekizawa 2 , Antonio Farina 3 . 1 Department of Obstetrics and Gynecology, University of Indonesia, Cipto Mangunkusumo National Hospital, Indonesia; 2 Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan; 3 Department of Histology and Embryology Division of Prenatal Medicine, University of Bologna, Bologna, Italy Objective: To study whether antioxidant supplementation (vitamin C and E) will reduce the incidence of preeclampsia among early gestation patients with low-antioxidat status. Methods: A randomized, placebo-controlled, double-blind clinical trial was conducted at University of Indonesia. Women between 8 and 12 weeks of gestation and have low antioxidant status were randomly assigned to daily treatment with vitamin C (1,000mg) and vitamin E (400 IU) or placebo. Analysis was adjusted for gestation age and other confounding factors. Results: Outcome data for 329 of 356 randomly assigned patients revealed no significant reduction in the rate of severe preeclampsia. Univariable risk of severe preeclampsia is 6.8% and 16.5% in supplementation and placebo group consecutively. However there was significant lower incident of mild preeclampsia in supplementation group compared with those of placebo with odd ratio 0.372 (0.178-0.775) p-value=0.008. There were no
differences in mean gestational age at delivery, birth weight, apgar score at 1 min. Conclusion: Supplementation of antioxidant was associated with a trend towards a lower incidence of mild preeclampsia.
T15.1 Left ventricular systolic and diastolic function and structure in women with untreated preeclampsia Alicia Dennis 1 , Julian Castro 2 , Scott Simmons 3 , Caroline Carr 4 , Michael Permezel 3 , Colin Royse 5 . 1 Mercy Hospital for Women Heidelberg & Royal Women’s Hospital, Parkville & The University of Melbourne, Australia; 2 St Vincents Hospital Fitzroy, Australia; 3 Mercy Hospital for Women Heidelberg & The University of Melbourne, Australia; 4 Mercy Hospital for Women Heidelberg, Australia; 5 The Royal Melbourne Hosptial & The University of Melbourne, Australia Background and aim: Preeclampsia is a major cause of maternal morbidity and mortality worldwide [1]. Studies of the underlying cardiac function in women with untreated preeclampsia have produced conflicting results however an understanding of cardiac function is needed to optimally treat these critically unwell women. The aim of this study was to determine left ventricular (LV) systolic function, diastolic function and LV mass using transthoracic echocardiography (TTE) in women with untreated preeclampsia. Method: Our previous study [2] determined the sample size and after institutional ethics approval and informed consent, forty women with untreated preeclampsia and forty gestationally matched healthy women were enrolled. After resting for a minimum of five minutes, heart rate (HR) and blood pressure (BP) were obtained and each woman underwent a standardised TTE examination [2]. Results: See Table 1. Table 1
Age (yr) Gestation (wks) BMI (kg/m2 ) MAP (mmHg) Cardiac output (ml/min) HR (BPM) SV (ml) SVR (dyne · cm/sec5 ) LVEDA (cm2 ) FAC (%) FS (%) Septal e velocity (cm/s) Mitral valve E/ septal e LV mass (g)
Healthy pregnant women (control), n=40
Women with untreated preeclampsia, n=40
P value
31.5±3.9 36.0±4.5 27.8±4.1 80.8±8.3 4109±595 77.8±9.6 53.2±7.9 1612.5±315.4 16.6±2.7 57.1±9.2 34.8±1.2 11.5±2.3 6.7±1.3 130±21
30.6±5.2 36.3±4.2 32.4±6.6 110.8±5.1 4789±1419 80.8±12.7 58.9±12.8 2015.7±624.7 16.6±2.6 64.5±9.3 40.9±7.6 8.7±2.3 10.4±2.4 189±40.1
0.35 0.76 <0.01 <0.01 <0.01 0.44 0.04 0.01 0.95 <0.01 <0.01 <0.01 <0.01 <0.01
Mean ± SD, LVEDA = left ventricular end diastolic area, FAC = fractional area change, FS = fractional shortening.
Conclusions: Women with untreated preeclampsia demonstrate increased cardiac output due to an increase in stroke volume, increased inotropy and significant diastolic changes. These findings support a hypothesis that preeclampsia impairs diastolic function and concurrently increases systolic function and inotropy. Reference(s) [1] Lewis, G. CEMACH 2003-2005. London; 2007. [2] Dennis A et al IJOA 2010 doi:10.1016/j.ijoa.2009.06.007
T15.2 Maternal cardiac function in severe preterm preeclampsia Karen Melchiorre 1 , George Sutherland 2 , Ingrid Watt-Coote 1 , Marco Liberati 3 , Basky Thilaganathan 4 , Aigul Baltabaeva 5 . 1 Fetal Maternal Medicine Unit, St George’s Hospital, University of London, London, UK; 2 Department of Cardiology and Cardiothoracic Surgery, St Georges Hospital, University of London, London, UK; 3 Department of Obstetrics and Gynecology University of Chieti, Chieti, Italy; 4 Fetal Maternal Medicine Unit St George’s Hospital, University of London, London, UK; 5 Department of Cardiology and Cardiothoracic Surgery, St George’s Hospital, University of London, London, United Kingdom, UK Introduction: Preeclampsia (PE) is a disease associated with significant