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Re: OB-GYN-L digest 374From: Michael A. Belfort (mbelfort@bcm.tmc.edu)Fri Dec 29 20:40:47 1995
Visser and Wallenberg have actually published (in the Br J Ob/Gyn) on the expectant management of HELLP Syndrome using volume expansion and antihypertensive therapy. They reported that a significant number of patients showed clinical improvement with volume expansion. Very few people in this country would be prepared to take such a risk but there is some merit to this approach. We have seen amelioration of severe epigastric and RUQ pain after volume expansion and nimodipine therapy (calcium channel blocker) in patients with HELLP syndrome. I think that quite possibly volume expansion plays an important role in decreasing vasospasm in the liver (perhaps by a stretch reflex that causes release of endothelial prostacyclin or NO). This is the reason we recommend at least 500 - 1000 cc volume expansion on admission in patients with HELLP syndrome who are not in cardiac failure.
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