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Re: HELLP SYNDROMEFrom: dahmd@gate.netThu Oct 17 18:08:48 1996
Doctor Joe (Pastorek) wrote:
>QUESTION, ARE BASELINE STUDIES AND 2 MORE AT 30 MIN INTERVALS And Daniel Braun, M.D. replied
>What are "baseline studies" ?
>It sounds to me like you have a case of pre-eclampsia,which you treated I believe the original post reported right upper quadrant pain. In any event, this sounds like rapidly developing severe preeclampsia. Given this scenario, I would obtain a serum chemistry (specifically liver function tests, creatinine, and I suppose a uric acid, although I have never found that a uric acid level has changed my management of a patient), and would also obtain a complete blood count (checking for thrombocytopenia and anemia). The right upper quadrant pain is disturbing as it can denote a liver hematoma or the development of "HELLP" syndrome. She would get MgSo4 until 24-48 hours after delivery, and antihypertensives if her blood pressure stayed above 160/105-110. I doubt that serial serum chemistries adds much, since it can take a long time for liver function tests to drop, even after delivery. Plus, even if they are elevated, you are treating the disease by delivering the baby. In some situations I find it valuabe to get them in 6-12 hours after the "baseline" chemistry panel to rule out developing abnormalities. I do think, however, that a CBC about every 6-12 hours is reasonable to rule out thrombocytopenia and anemia (i.e. "HELLP" syndrome) since both of these may affect the route of delivery, and may lead you to crossmatch blood and/or platelets. I'll bet that everybody has a different opinion on this situation, which probably reflects both our relative lack of understanding about preeclampsia, and the rather dogmatic approach to Ob/Gyn management that unfortunately exists entirely too often in our specialty. Thanks, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, FL
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