Document Detail


Factors relevant to mode of preterm delivery with syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelets).
MedLine Citation:
PMID:  8203445     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our purpose was to investigate factors relevant to mode of delivery for patients with preterm (< 34 weeks) gestation complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP). STUDY DESIGN: The pregnancies of 189 patients with HELLP syndrome and delivery < 34 weeks' gestation between January 1980 and October 1991 were studied retrospectively. Only patients with class 1 (platelet nadir < or = 50,000 per microliter, n = 83) and class 2 (platelet nadir > 50,000 to < or = 100,000 per microliter, n = 106) HELLP syndrome were included. Maternal and perinatal factors relevant to type of delivery were reviewed. RESULTS: The incidence of cesarean delivery for all patients was 76.2% (primary rate 72.4%). Abdominal delivery occurred equally between class 1 (78.3%) and class 2 (74.5%) patients. Cesarean section was the mode of delivery for 87% of pregnancies at < 30 weeks' gestation in contrast to 68% of pregnancies at > or = 30 weeks but < 34 weeks' gestation (odds ratio 3.2, 95% confidence interval 1.4 to 7.5, p < 0.005). Indications for cesarean section included deteriorating maternal condition alone (50%), deteriorating maternal and fetal condition (27%), nonvertex fetal presentation (11.5%), and failure to progress (11%). Induction of labor was significantly more successful during the > or = 30 but < 34 weeks' pregnancy interval (47.5%) than in pregnancies at < 30 weeks (15.2%) (odds ratio 0.2, 95% confidence interval 0.1 to 0.55, p < 0.001). A trial of labor was successful in 22% of patients with an initial modified Bishop score < or = 2 versus 45% with an initial Bishop > 2 (odds ratio 0.5, 95% confidence interval 0.2 to 1.3, p = 0.16). CONCLUSION: Parturients with class 1 and 2 HELLP syndrome at < 34 weeks' gestation are at high risk for cesarean delivery. At a gestational age < 30 weeks, the likelihood of successful labor induction with vaginal delivery is remote, especially in association with an unfavorable cervix or the absence of labor.
Authors:
E F Magann; W E Roberts; K G Perry; S P Chauhan; P G Blake; J N Martin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  170     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1994 Jun 
Date Detail:
Created Date:  1994-07-07     Completed Date:  1994-07-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1828-32; discussion 1832-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cesarean Section / statistics & numerical data
Delivery, Obstetric / statistics & numerical data*
Female
Gestational Age
HELLP Syndrome*
Humans
Infant, Newborn
Infant, Premature*
Labor, Induced
Pregnancy
Retrospective Studies
Trial of Labor

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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