Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)

OBJECTIVE: Our objective was to categorize the histologic findings in the liver in patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and to correlate these findings with the severity of clinical laboratory abnormalities. STUDY DESIGN: Eleven patients with laboratory criteria for HELLP syndrome who required cesarean delivery underwent needle biopsy of the liver under direct visualization. RESULTS: Eight patients had periportal hemorrhage, and six had fibrin deposition. Fatty infiltration was seen in four, one with large-droplet fat, three with microvesicular fat. There was no statistically significant correlation between the severity of the histologic findings of periportal hemorrhage and fibrin deposition and the clinical laboratory findings. Fatty infiltration did not correlate with the severity of the HELLP syndrome's histologic condition, but, in contrast, did correlate with thrombocytopenia and aminotransferase elevations. CONCLUSIONS: Laboratory abnormalities do not accurately reflect the severity of the underlying histopathologic condition in HELLP syndrome. We propose that all patients with HELLP syndrome, regardless of the degree of their laboratory abnormalities, be treated aggressively, primarily with delivery.

Fetal blood sampling in patients undergoing elective cesarean section: a correlation with cord blood gas values obtained at delivery.

The purpose of this study was to compare blood gas parameters obtained after delivery and cord clamping with those obtained in the intact fetal circulation. Eighteen patients undergoing elective cesarean section at term were studied. Before the induction of epidural anesthesia, cordocentesis was performed under ultrasonographic guidance. Subsequently, a second sample was obtained for cord blood gas analysis after delivery. Umbilical venous blood was analyzed for pH, PO2, PCO2, and base excess. When comparing samples obtained from the intact fetal circulation with those obtained after delivery, there was a significant difference in pH (7.36 +/- 0.03 vs 7.31 +/- 0.04; p less than 0.0001), PCO2 (41.15 +/- 3.66 vs 46.29 +/- 5.71; p less than 0.018), PO2 (32.92 +/- 8.54 vs 26.97 +/- 4.43, p less than 0.02), and base excess (-0.79 +/- 1.19 vs -2.36 +/- 1.48; p less than 0.0003). These results should be considered when cord blood gas values obtained at delivery are correlated with those from the prenatal fetal state. Blood gas values obtained at delivery may not reflect the true prenatal fetal acid-base status.

The effect of nifedipine therapy on fetal and placental Doppler waveforms in preeclampsia remote from term.

Twenty patients with preeclampsia at a gestational age of 26 to 35 weeks were treated with oral nifedipine until delivery. The mean oral daily dose was 45.1 +/- 11 mg/day (range, 40 to 80 mg/day). Fetal aorta, internal carotid artery, umbilical artery, and uteroplacental Doppler flow velocity waveforms were recorded before treatment and then serially. The mean nifedipine concentration at the time of the Doppler studies was 60.3 ng/ml (range, 10 to 90 ng/ml). The use of nifedipine therapy was associated with a significant decrease in both maternal systolic blood pressure (baseline, 154 to 135 mm Hg, p less than 0.001) and diastolic blood pressure (baseline, 100 to 88 mm Hg, p less than 0.001). However, there was no significant difference in the resistance index between baseline and postnifedipine Doppler studies in either the fetal or uteroplacental vessels. The use of oral nifedipine to control blood pressure in preeclampsia does not affect the resistance indices in fetal or uteroplacental vessels as measured by the Doppler technique.