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Re: Advice following severe pre-eclampsiaFrom: fuf@gulf.netTue Nov 25 12:43:25 1997
>Do you say anything different? >Pete Harris O&G SpR (trainee) East Anglia UK (now in Norwich) For the most part, sounds like good advice. The recurrence risks of preeclampsia/HELLP vary with population characteristics. For studies from the South, with primarily indigent populations, the recurrence risk of preeclampsia and HELLP is high. Sibai's article was already referenced. Martin's group in Mississippi also reported a recurrence risk for preeclampsia of close to 50% and for HELLP of close to 25% for patients who had HELLP syndrome in a prior pregnancy (Am J Obstet Gynecol 1994 Oct;171(4):940). Other populations seem to report a lower risk consistent with Dr. Harris' letter. For example, Neisert, in Germany (Geburtshilfe Frauenheilkd 1996 Feb;56(2):93-6 reference from Knowledgefinder Medline- did not read article) reported a recurrence risk in these patients of 28% for preeclampsia and 5% for HELLP. I wouldnt be surprised if the Dr. Harris' East Anglia population, has risks closer to the German study. There is no convincing evidence that Aspirin or Calcium can prevent recurrent PIH, but they dont seem to hurt. I give baby ASA from the positive pregnancy test until the second wave of implantation is completed in mid 2nd trimester. I supplement these patients with about 1.5 gram calcium daily. As far as VBAC is concerned...yes, if the patient is very motivated and signs a Phalen form which clearly states an increased risk of serious and life threatening complications to baby and mother. Gary Klenman, MD Perinatologist/Geneticist
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