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Volume 168 Number I, Part 2

CORTICOSTEROIDS FOR THE ENHANCEMENT OF FETAL LUNG MATURITY: IMPACT ON THE GRAVIDA WITH PREECLAMPSIA AND HELLP SYNDROME. E.F. Mafann, R.W. Martin, J,D. Isaacsx, P.G. BlakeX, J.C. ROrr son, J.N. Martin, Jr. Dept. Ob/Gyn, University of Mississippi Medical Center, Jackson, MS. OBJECTIVE: To determine the maternal Impact of corticosteroids, administered for the promotion of fetal lung maturity In patients with HELLP syndrome, on the antepartum platelet count, Increased LDH values, and other Indices of hepatic dysfunction. STUDY DESIGN: In this retrospective, matched control study, 27 of 427 women wi th HELLP syndrome treated between 1980 and 1991 received a full course of steroids prior to preterm delivery. This consisted of dexamethasone 5 mg Intramuscularly every 12 hours for 4 doses. Delivery occurred> 24 hours but < 7 days after the final Injection. This group was compared to 27 contro I pat I ents wi th HELLP syndrome who recel ved no corticosteroids. Subjects were matched for maternal age, race, sex of the fetus, and severity of HELLP syndrome. RESULTS: The predel Ivery platelet count stablllzed or Increased In 25 of 27 steroid-treated women In contrast to 0 of 15 control women (p < 0.00001). In comparison to control patients, LDH, SGOT/AST and SGPTlALT In steroid-treated patients stablllzed or decreased during therapy compared to nontreated women (p < 0.005). Delivery to diuresis time was lS.3 + 12.9 hours In the steroid-treated group and 29.7 + 45 "ours In the control group (p • NS). In addition, tne Interval from delivery to platelet nadir In patients with Class III HELLP syndrome was shorter I n the sterol d-treated group (p < 0.008) than untreated patients; these were similar with Class I-II HELLP. CONCLUSION: Antenatal steroid use for enhancement of fetal lung maturation In patients with HELLP syndrome appears to stabilize and temporarily reverse the severity of the underlying maternal disease process apparently without sequelae.

STANDARD PARAIETERS OF PREECLAMPSIA: ARE THEY RELIABLY PRESENT IN PATIENTS WITH HELLP SYNDRM? E.F. Malann, S.P. Chauhanx , R.W. NaefX, M.L. MortonX, J.e. ROrr son, J.N. Martin, Jr. Dept. Ob/Gyn, University of Mississippi Medical Center, Jackson, MS. OBJECTIVE: To determine In women with HELLP syndrome the relationship between blood pressure, proteinuria, and uric acid and this variant of severe preeclampsia. STUDY DESIGN: Four hundred fifty-four gravid women were Identified with HELLP syndrome during a lS0-month period (January 1980 and May 1992). Peak antepartum and postpartum systolic and diastolic blood pressure, proteinuria, and uric acid were obtained on each patient. In addition to elevated LDH values and other laboratory evidence of hemolysiS and hepatic dysfunction, a perinatal platelet count < SO,OOO/uL was designated as Class I HELLP syndrome, Crass I! as a pI atel et nadl r > SO,OOO and < 100,000/uL, and Class III > 100,000 and < 150,000/uL. -RESULTS: Diastolic blood pressures never exceeded 90 mm Hg In 10.~, 8.S~, and 4.5~ of patients with Class I, II, and II! HELLP syndrome, respectively. Class I HELLP syndrome had peak antepartum systo II c blood pressure < lS0 mm Hg significantly more often than Class II (p < 0.0091) and Class III (p < 0.04). Class I HELLP syndrome had significantly more patients with 0 - 2+ proteinuria than Class III HELLP syndrome (p < 0.002), and Class III HELLP syndrome had significantly more women o - 2+ protei nurl a than Cl ass II HELLP syndrome (p < 0.001). Peak postpartum systolic blood pressure, antepartum and postpartum diastolic blood pressure, and uric acid levels were not significantly different for any specific class of HELLP syndrome. CONCLUSIONS: Blood pressure elevation, hyperuricemia, and proteinuria, which are essential for the diagnosis of preeclampsia/eclampsia and reflect disease severity, are not uniformly present In patients with HELLP syndrome nor do they appear to consistently reflect the seriousness of this severe variant of preeclampsia/eclampsia.

SPO Abstracts 387

326 CIRCADIAN RHYTHM OF BLOOD PRESSURE IN NORMOTENSIVE AND PREECLAMPTIC PREGNANCIES. M. Herzog Carr" M.D., D. Worthington, M.D., Depl. Ob/Gyn, SI. Joseph's Hospital, Milwaukee, WI. OBJECTIVE: To compare patterns of blood pressure in normotensive and preeclamptic patients. STUDY DESIGN: Investigation of circadian rhythms of blood pressure was performed in both ambulatory and hospitalized pregnant subjects. Of the 38 women studied, 14 were normotensive; 17 had mild preeclampsia, and seven were severely preeclamptic. Blood pressures were obtained every three to six hours over a 24 hour period with an automatic blood pressure device. The two blood pressures obtained during the night (between midnight and eight a.m.) were averaged and compared to the average of the two pressures obtained during the day (between noon and eight p.m.). RESULTS: A statistically significant drop in the nocturnal blood pressure was seen in both ambulatory and hospitalized subjects in the normotensive group (p < .05). No significant drop in nocturnal blood pressure was seen in either of the preeclamptic groups. In fact, a nocturnal hypertension was observed and is more apparent in the those with severe preeclampsia. CONCLUSIONS: The circadian rhythm of blood pressure in normal pregnancy is similar to that in the non-pregnant state, with the lowest blood pressure occurring during sleep, and the highest pressure occurring during the day. This rhythmic variation in blood pressure is lost or suppressed in women with preeclampsia. In women with severe preeclampsia a reversal of the circadian blood pressure rhythm has been shown. This progression from a normal circadian rhythm of blood pressure to a blunted rhythm and finally to a reversal of the rhythm in some women with preeclampsia may have both clinical and therapeutic relevance. In addition, it may also provide a clue to the etiology of the disease process.

327 AMBULATORY BLOOD PRESSURE MONITORING DURING PREGNANCY: NORMATIVE DATA IN NORMOTENSIVE GRAVIDAS. C. Smith. A Miller, W. Rayburn, DeptofOB/GYN, Univ of Nebr, Omaha, NE. OBJECTIVE: To establish normative values for ambulatory BP monitoring in pregnant patients without evidence for hypertension. STUDY DESIGN: Twenty-one (21) uncomplicated pregnancies underwent continuous ambulatory BP monitoring with a Space Labs 90207 monitor. This device recorded BP at 10 minute inteNals during the day and 30 minute inteNals at night. Mean systoliC and diastolic BP, mean arterial pressure (MAP) and percentage of values 2. 140 systolic and 2. 90 mm Hg diastolic were calculated. RESULTS: The device was used for an average of 27.2 hours and measured the BP an average of 85.6 times. Successful readings were reported in 83% of measurements. Systolic BP, diastolic BP and MAP averaged 111.9.±. 6.9, 66.1.±. 6.2, AND 81.3.±. 6.9 mm Hg respectively. Systolic BP exceeded 140 mm Hg an average of 2.1 .±. 4.5% (range 0-19.3%) of measurements and diastolic BP was greater than 90 mm Hg an average of 2.9.±. 3.1% (range 0-10.2%) of readings. CONCLUSIONS: A total of 15 (71.4%) normal patients demonstrated abnormal BP elevations during continuous monitoring, yet did not meet traditional criteria for hypertension as an outpatient. This normative data should be considered when applying this technology to hypertensive gravidas.