e28 Abstracts / European Journal of Obstetrics & Gynecology and Reproductive Biology 234 (2019) e1–e131
Hypertensive Disorders in Pregnancy
Session 10 – Obstetrics: Hypertension
Reference: A2404EP
Clinical management of severe preeclampsia
Tatyana Skovorodina, Evgeniya Polushkina ∗ , Olga
Ivanova, Roman Shmakov
National Medical Research Center Obstetrics,
Gynecology and Perinatology, V.I. Kulakov Ministry
of Healthcare of the Russian Federation, Moscow,
Russia
Introduction: In recent years, preeclampsia has been divided
into two forms: early preeclampsia and late preeclampsia, which
differ in the severity of the flow and in the outcomes for the
mother and fetus. If, in severe late preeclampsia, tactics are defined
and reduced to immediate delivery, then in the early course of
preeclampsia, the issue of the possibility of prolonging pregnancy
remains very debatable.
Objective: Comparison of active and expectant management of
women with early severe preeclampsia.
Methods: The state of health of 53 women with early severe
preeclampsia and their newborns was analyzed. Women were
divided into 2 groups. 1 group comprised 25 pregnant women,
with expectant management tactics, 2 group comprised 28 women,
with active tactics of reference. A comprehensive assessment of the
state of health of pregnant women was carried out using physical,
clinical and laboratory methods of investigation, average terms of
prolongation of pregnancy, delivery with active management and
expectant management of treatment, and anthropometric data of
newborns were estimated.
Discussion and conclusions: In group 1, the average dura-
tion of prolongation of pregnancy was 7.28 ± 1.41 days. In group
2, the maximum duration of prolongation of pregnancy was 2
days. The average length of delivery for the groups was 30.4 ± 3.91
and 32.86 ± 3.52 weeks, respectively. The main cause of prema-
ture delivery in both groups was an increase in the severity of
preeclampsia and the absence of the effect of the therapy. In group
1, CPAP therapy was used as a treatment for severe preeclampsia
in 28% of women (n = 7), in group 2 – in 3.4% of women (n = 2). With
the use of CPAP therapy, the average duration of the prolongation of
pregnancy increased by 5.3 days (mean – 11 days) compared with
the group of women without respiratory support CPAP (mean – 5.7
days).
https://doi.org/10.1016/j.ejogrb.2018.08.214
Hypertensive Disorders in Pregnancy
Session 10 – Obstetrics: Hypertension
Reference: A2346PG
Expectant versus active management of HELLP
syndrome
Florence Cadoret 1 , Fabien Vidal 1,3 , Olivier
Parant 1,3 , Christophe Vayssiere 1,3 , Paul
Guerby 1,2,3,∗
1 Obstetrics and Gynaecology Department, CHU
Toulouse, Toulouse, France
2 INSERM UMR 1048, Toulouse, France
3 Université Toulouse III, Toulouse, France
Introduction: Management of HELLP syndrome occurring
before 34 weeks of gestation is still controversial since its evolutive
profile remains unpredictable. Hence most authors recommend
active management with prompt delivery, whose benefit should
be balanced with induced prematurity.
Objective: Herein we aimed to describe a subgroup of women
with (H)ELLP syndrome who were managed expectantly.
Methods: All patients with (H)ELLP syndrome managed in our
tertiary care unit from 2003 to 2016 were enrolled in this ret-
rospective study. They were stratified according to obstetrical
management. In active management group, delivery was initi-
ated immediately after administration of antenatal betamethasone
therapy (group 1). In expectant management group, pregnancy was
prolonged beyond betamethasone therapy until maternal or fetal
follow up indicated delivery (group 2).
Discussion and conclusions: Overall 99 patients were included.
Among them, 61 were managed expectantly. We did not observe
any difference between groups in maternal demographics, fetal
weight and term of gestation at the onset of disease. How-
ever, group 1 patients displayed poorer clinical, biological and
ultrasound features at admission justifying the immediate deliv-
ery decision: increased creatinine value (81.2 vs 68.9 ␮mol/L,
p = 0.01), decreased prothrombin (91 vs 96, p = 0.04), hyperreflexia
(p < 0.001), severe headache (p = 0.006), confusion (p < 0.01) and
altered ductus venosus (p = 0.007). Perinatal outcomes were sim-
ilar in both groups. Expectant management allowed a 7.7 days
pregnancy prolongation in this period of periviability.
Expectant management may be suitable for a subgroup of
patients presenting with moderate and stable (H)ELLP syndrome
allowing the continuation of the pregnancy with a close follow up.
In contrast, prompt delivery should be indicated in case of non-
reassuring maternal and/or fetal conditions.
https://doi.org/10.1016/j.ejogrb.2018.08.215