Obstetric implications of antepartum corticosteroid therapy for HELLP syndrome.
OBJECTIVE
We reviewed the impact of intravenous high-dose corticosteroid administration for preterm hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome on vaginal delivery rate and degree of clinically significant thrombocytopenia.


METHODS
Retrospective analysis of 1991-2000 HELLP syndrome (platelets < 100,000/uL, lactate dehydrogenase > 600 IU/L, aspartate aminotransferase and/or alanine aminotransferase > 70 IU/L) data focusing on labor inductions for gestations of less than 34 weeks and increase in platelet count sufficient to permit regional anesthetic techniques.


RESULTS
Antepartum high-dose corticosteroid use increased from 32% (1991-1995) to 67% (1996-2000) for 350 patients studied (n = 199, < 34 weeks; n = 151, > 34 weeks). Corresponding vaginal delivery rates were 32% for gestations of less than 30 weeks, 61% at 30-31 weeks, and 62% at 32-33 weeks. Similarly, 27% of patients with a platelet count of less than 75,000/uL and 52% with a platelet count of less than 100,000/uL who received high-dose corticosteroids during the study interval subsequently achieved a 100,000/uL threshold in time to perform regional anesthesia for delivery.


CONCLUSIONS
Administration of intravenous high-dose corticosteroids for preterm HELLP syndrome increases probability of successful labor induction and candidacy for regional anesthesia.


METHODS
II-3.
Rose
Carl H
CH
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA. crose@ob-gyn.umsmed.edu
Thigpen
Brad D
BD
Bofill
James A
JA
Cushman
Julie
J
May
Warren L
WL
Martin
James N
JN
D000765:Anesthesia, Conduction; D000773:Anesthesia, Obstetrical; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D017359:HELLP Syndrome / Q000188:drug therapy*; D006801:Humans; D007751:Labor, Induced; D010976:Platelet Count; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies
D005938:Glucocorticoids; D003907:Dexamethasone