title: Microcirculation in women with severe pre-eclampsia and HELLP syndrome: a case-control study.
abstract: OBJECTIVE
  To compare microcirculatory perfusion in women with severe pre-eclampsia against that in healthy pregnant women, and secondly in women with severe pre-eclampsia with or without HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets).
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  University Hospital Rotterdam, the Netherlands.
  
  
  METHODS
  Twenty-three women with severe pre-eclampsia and 23 healthy pregnant controls, matched for maternal and gestational age. Out of the 23 women with severe pre-eclampsia, ten presented with HELLP syndrome.
  
  
  METHODS
  Microcirculation was analysed sublingually by a non-invasive sidestream dark-field imaging device (SDF).
  
  
  METHODS
  Perfused vessel density (PVD), microcirculatory flow index (MFI), and heterogeneity index (HI) were calculated for both small vessels (∅ < 20 μm; capillaries) and non-small vessels (∅ > 20 μm; venules and arterioles).
  
  
  RESULTS
  There were no significant differences between women with severe pre-eclampsia and healthy controls. Women with pre-eclampsia and HELLP syndrome showed a reduced PVD (P = 0.045), MFI (P = 0.008), and increased HI (P = 0.002) for small vessels, as compared with women with pre-eclampsia but without HELLP syndrome.
  
  
  CONCLUSIONS
  Sidestream dark-field is a novel, promising technique in obstetrics that permits the non-invasive evaluation of microcirculation. We did not observe major differences in sublingual microcirculatory perfusion between women with severe pre-eclampsia and healthy pregnant controls. In women with severe pre-eclampsia, the presence of HELLP syndrome is characterised by impaired capillary perfusion.
authors.affiliation: Department of Obstetrics & Gynaecology, Division of Obstetrics & Prenatal Medicine, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Cornette
authors.forename: E
authors.initials: E
authors.lastname: Herzog
authors.forename: E A B
authors.initials: EA
authors.lastname: Buijs
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.forename: D
authors.initials: D
authors.lastname: Rizopoulos
authors.forename: W C J
authors.initials: WC
authors.lastname: Hop
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.forename: E A P
authors.initials: EA
authors.lastname: Steegers
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D017359:HELLP Syndrome / Q000503:physiopathology*; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D055806:Microvessels / Q000502:physiology*; D009060:Mouth Floor / Q000098:blood supply*; D009426:Netherlands; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy
keywords: Capillary; HELLP syndrome; microcirculation; microcirculatory perfusion; pre-eclampsia; sidestream dark-field imaging