Clinical

Short delivery delay not harmful in low platelets syndromes

Last Updated: 2014-02-13 17:39:38 -0500 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Mothers-to-be with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and elevated liver enzymes, low platelets (ELLP) syndrome may benefit from delayed delivery, according to UK researchers.

These syndromes are rare, Dr. Marian Knight told Reuters Health by email, and "can be associated with major complications for both mother and baby, in which the usual management is early delivery. This study suggests that delivery can be delayed by a short period, of up to two days, to allow for other treatments which may help reduce complications."

In a February 4 online paper in Obstetrics and Gynecology, Dr. Knight of the University of Oxford, UK, and colleagues note that the conditions are usually seen in women with symptoms of preeclampsia. Incidence is unclear with estimates varying from five to 76 per 10,000 deliveries and between 8% and 24% of women with severe preeclampsia or eclampsia.

To gain further information, the researchers conducted a population-based nationwide case-control study. This involved 129 women diagnosed with HELLP, 81 diagnosed with ELLP, and 476 controls.

After adjustment, compared to controls, women with HELLP were more likely to be 35 years of age or older (odds ratio, 1.85), nulliparous (OR, 4.16), and have had a previous gestational hypertensive disorder (OR, 3.47). They were also more likely to have a multiple pregnancy (OR, 4.51).

In the ELLP group, adjusted odds ratios were 8.35 for nulliparity and 4.66 for a previous gestational hypertensive disorder.

Of the women diagnosed antenatally with HELLP or ELLP, 51% had planned management of immediate delivery, 43% had delivery planned within 48 hours, and only 5% had planned expectant (conservative) management.

Of the seven women who had such conservative management, two received blood products and five were admitted to the ICU, but none experienced severe morbidity or died.

Overall, women with HELLP syndrome were significantly more likely than those with ELLP to have received magnesium sulfate (76% vs. 62%), but there were no other significant differences in management.

The researchers note that "there is a high rate of eclampsia among both women with ELLP and HELLP; thus, obstetricians should consider magnesium sulfate prophylaxis alongside delivery planning."

No differences were found between those with planned delivery within 48 hours and planned immediate delivery for receipt of blood products (37% vs. 33%), ICU admission (57% vs. 61%), having severe morbidity (10% vs. 4%), and having a neonate with major complications (6% vs. 11%).

The lack of outcome difference here, concluded Dr. Knight, "is particularly relevant when mothers are affected by HELLP or ELLP syndrome relatively early in their pregnancies, when maternal treatment with steroid injections can be given to help mature the baby's lungs and reduce breathing difficulties after birth."

SOURCE: http://bit.ly/MP7YJT

Obstet Gynecol 2014.