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Re: Magann, Am J Ob/Gyn 1994;171:1148From: Gary Kleinman (fuf@gulf.net)Wed Dec 27 12:41:58 1995
A 40 y/o g2p0 with no history of hypertension was transferred to our unit at 29 weeks 5 days ago with severe headache and RUQ pain for one day. The pregnancy was uncomplicated until the present. Her pressures were 179/115 on admit. Platelets were 100,000; HCT 36; SGOT and SGPT were 85 and 79 repectively. The uric acid was 6.5. Urine protein was 2+. The patient had hyprerreflexia and clonus. The fetus measured 1250 grams; the AFI was 11 and the umbilical doppler ratio 3.4/1. The fetal tracing was reassuring. She was started on magnesium and given betamethasone, 12 grams IM. Steroids were repeated at a dose of dexamethasone 10 mg IV bid continuously. The labs inmproved on each draw. Now, 5 days after admit, her BP is 130/70. her protein is gone. The RUQ pain and headache disappeared on the first day of admission. The reflexes have been normal since day 2. The SGOT and SGPT are 21 and 29 respectively. The platelets are 140,000 and the HCT 31. The uric acid is 4.5. 24 hour urine protein = 221 mg and dipsticks are trace. An amnio for maturity has not been done. The baby's karyotype is 46,XY. The ANA is pending as are antiphospholipid antibody tests. The fetal biophysical is reassuring. Magann et all have published (in a group of 25 patients) that bid high doses of dexamethasone till delivery extended the latent period (admission until delivery) of HELLP syndrome from 15 to 41 hours. Should I keep the high dose of steroids? Magann reported worsening HELLP post partum after the steroids were stopped. Has this work been confirmed? Any suggestions?
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