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Temporising management of severe pre-eclampsia with and without the HELLP syndrome
1Department of Obstetrics and Gynaecology, Erasmus University School of Medicine and Health Sciences, Rotterdam, The Netherlands.
Objective:
To test the null hypothesis that the course and outcome of pregnancy in patients with severe pre-eclampsia receiving temporising haemodynamic treatment does not depend on the presence or absence of the syndrome of haemolysis, elevated liver enzymes, and a low platelet count (HELLP).
Design:
A case-controlled study.
Setting:
High risk obstetric unit, University Hospital Rotterdam-Dijkzigt, Rotterdam.
Subjects:
One hundred and twenty-eight consecutive pre-eclamptic patients with HELLP, gestational age less than 34 weeks, matched for maternal and gestational age with 128 pre-eclamptic patients without HELLP.
Intervention:
Both groups were treated with volume expansion and pharmacologic vasodilatation under invasive haemodynamic monitoring with the aim of prolonging gestation and enhancing fetal maturity.
Main Outcome Measures:
Maternal and perinatal outcome in patients with and without HELLP.
Results:
Except for variables pertaining to HELLP, clinical and laboratory data and median prolongation of pregnancy did not differ between both groups. Complete reversal of HELLP occurred in 43% of patients. Perinatal mortality was 14.1% in HELLP patients and 14.8% in patients without HELLP. No maternal complications occurred.
Conclusion:
We cannot reject the null hypothesis. Our data do not support a general recommendation of prompt termination of pregnancy in HELLP. Temporising treatment may improve fetal and neonatal as well as maternal outcome.