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HELLP & steroidsFrom: Joshua Copel (Joshua.Copel@QuickMail.Yale.edu)Thu Dec 28 06:04:32 1995
Subject: Time: 7:53 AM OFFICE MEMO HELLP & steroids Date: 12/28/95 HELLP syndrome often worsens postpartum so that alone is not a severe criticism of Magann's paper. Since Sibai's group has shown that conservative management of severe preeclampsia remote from term can add a mean of 14 days to the gestation (paper presented at SPO in 1994, not sure when it was published, maybe 9/94 Am J Ob Gyn), it is not impossible that just bedrest with hydration (which is critically important for these intravascularly depleted patients) and appropriate anticonvulsant therapy could result in transient improvement. I am sure that Magann's group will follow with an RCT. Outside of such a protocol I'm not sure of a role for steroids in this setting, aside from the obvious use to enhance fetal lung maturation. Incidentally, we use TRH per Ballard's protocol for extremely prematures in this setting (Lancet 1992;339:510-515). If you do, give them slooooowly, as rapid infusion has been reported to cause severe exacerbation of hypertension in preeclampsia. Josh Copel Yale Ob-Gyn, MFM Joshua.Copel@Yale.edu
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