Consider IOL in women with preterm severe preeclampsia/HELLP

  • Am J Obstet Gynecol

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Women with successful induction of labor (IOL) for preterm severe preeclampsia and hemolysis, elevated liver enzymes, and low platelets (HELLP) have better maternal and neonatal outcomes compared with those with failed IOL and planned cesarean delivery (CD).

Why this matters

  • Better predictors are needed to see who will benefit from an IOL vs planned CD.

Key results

  • Women with IOL were more likely to be younger, nulliparous, and presenting at a later gestational age.
  • IOL success rate was 47%.
  • Women with planned CD were more likely to be obese and have chronic hypertension, prior CD, or fetal growth restriction (P<.01>
  • IOL was less likely to be associated with placental abruption, wound infection or separation, and neonatal asphyxia.
  • Failed IOL was associated with increased maternal morbidity compared with successful IOL (adjusted relative risk, 2.49; 95% CI, 0.63-9.82).  

Study design

  • Secondary analysis of data from the Consortium on Safe Labor, a retrospective cohort study from 12 US clinical centers between 2002 and 2008.
  • Pregnancies complicated by preeclampsia with severe features and HELLP syndrome delivered between 24 weeks 0 days and 33 weeks 6 days identified (n=914).
  • Maternal and neonatal outcomes compared to IOL (n=460) vs planned CD (n=454).
  • Funding: Graduate Medical Education program, MedStar Washington Hospital Center.

Limitations

  • Retrospective data.

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