Conservative versus active management in HELLP syndrome: results from a cohort study

Cavaignac-Vitalis, Marie; Vidal, Fabien; Simon-Toulza, Caroline; Boulot, P.; Guerby, Paul; Chantalat, Élodie; Parant, Olivier

doi:10.1080/14767058.2017.1416604

Cited by 10 publications

(4 citation statements)

References 22 publications

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“…Risk-benefit after this should be strongly considered on a case-by-case basis, depending on resources, gestational age, and difficulty in hypertension control. Based on this study and previous studies [7][8][9][10][11][12], expectant management is beneficial to perinatal outcomes. However, these data were insufficient to establish conclusions regarding maternal health.…”

Section: Discussionsupporting

confidence: 54%

Pregnancy Outcomes of Conservative Management in Preeclampsia with Severe Features

Inta,

Tongsong,

Srisupundit

2023

JCM

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Objective: To study the pregnancy outcomes of conservative treatment for preeclampsia with severe features. Methods: A retrospective study was conducted on pregnancies with preeclampsia with severe features at gestational age 23–34 weeks and that received conservative management at Chiang Mai University Hospital between January 2014 and August 2020. The women were divided into two groups: (1) pregnancy prolongation of at least 48 h and (2) pregnancy prolongation of less than 48 h. Results: Of the 100 recruited pregnancies, the median gestational age was 29 weeks (range 23–34). Of these, 65 cases (65%) had pregnancy prolongation of at least 48 h, and 35 cases (35%) had prolongation of less than 48 h. The median pregnancy prolongation was 2.9 days (range 4 h–27.7 days). Eighty-seven (88%) pregnant women experienced no complications. Multivariate analysis shows that high urine protein/creatinine ratio (UPCI) at admission was significantly associated with pregnancy prolongation of less than 48 h with an odds ratio for prolongation for at least 48 h of 0.86 (95% CI 0.75–0.99: p-value 0.04). Kaplan–Meier analysis shows that the mean time of prolongation was 3.6 days vs. 6.7 days, and median time of prolongation was 2.1 days vs. 4.4 days in the group of high and low UPCI (using cut-off 1.0), respectively. The number of prolonged days was significantly lower in the high UPCI group than in the low UPCI group (log-rank test, p = 0.01). The maternal and fetal outcomes between the two groups were not significantly different. The cesarean section rate was also comparable. The mean birth weight and gestational age at delivery were not significantly different, though they had a higher trend in the group of successful conservative management. Conclusion: The rate of pregnancy prolongation of at least 48 h with conservative management was 65%, with a median prolongation time of 2.9 days. A new insight gained from this study is that high UPCI at admission is an independent factor for prolongation of less than 48 h with conservative treatment. Nevertheless, the maternal and fetal outcomes between the two groups were not significantly different. Therefore, the benefit and risk of expectant management in actual practice of service settings in terms of maternal and fetal morbidity is still unclear.

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Section: Discussionsupporting

confidence: 54%

Pregnancy Outcomes of Conservative Management in Preeclampsia with Severe Features

Inta,

Tongsong,

Srisupundit

2023

JCM

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“…Asimismo, el manejo expectante se asoció con una tasa significativamente menor de complicaciones neonatales (síndrome de dificultad respiratoria, sepsis, enterocolitis necrotizante, hemorragia intracerebral y transfusión de sangre). Concluyeron que el manejo expectante puede ser beneficioso tanto para la madre como para el recién nacido en pacientes con SH estable (26) .…”

Section: Vía Y Momento Del Partounclassified

Diagnóstico y manejo oportunos del síndrome HELLP

Díaz

Cabrera

2020

Rev peru ginecol obstet.

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El síndrome HELLP (SH) es una complicación severa del embarazo caracterizada por hemólisis, enzimas hepáticas elevadas y plaquetopenia. Es una de las situaciones más graves del embarazo, provocando tasas elevadas de morbimortalidad maternoperinatal. La complicación más frecuente del SH es la hemorragia, necesitándose transfusión de sangre y/o hemoderivados para corregir la hipovolemia, anemia o coagulopatía, siendo la complicación más catastrófica el hematoma hepático espontáneo. El parto es el único tratamiento efectivo para el SH. La mortalidad perinatal está relacionada directamente con la edad gestacional. No se ha logrado consenso sobre el manejo del SH que ocurre antes de las 34 semanas de gestación, cuando las condiciones maternas y fetales son estables. El objetivo de la presente revisión es resumir la información existente sobre el manejo oportuno del SH. Se concluye que la vía del parto dependerá de las condiciones cervicales y la estabilidad materno-fetal. Se necesitan estudios adecuados para determinar si hay beneficio con el manejo expectante en gestaciones pretérmino, y la administración de corticoides para mejorar el recuento de plaquetas en el SH.

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“…Por supuesto, los beneficios del manejo conservador se deben balancear con el riesgo de aparición de complicaciones tanto maternas como fetales. En un reciente estudio de cohortes que comparaba manejo activo con manejo conservador y que incluía 118 pacientes, se observó un mayor riesgo de hemorragia postparto y de morbilidad neonatal en el grupo de manejo activo, permitiendo el manejo conservador alargar la gestación de tres a 30 días 15 .…”

Section: Manejo Del Síndrome Hellpunclassified

Síndrome HELLP: controversias y pronóstico

Lastra

Fernández

2020

Hipertensión y Riesgo Vascular

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Conservative versus active management in HELLP syndrome: results from a cohort study

Cited by 10 publications

References 22 publications

Pregnancy Outcomes of Conservative Management in Preeclampsia with Severe Features

Pregnancy Outcomes of Conservative Management in Preeclampsia with Severe Features

Diagnóstico y manejo oportunos del síndrome HELLP

Síndrome HELLP: controversias y pronóstico

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