Table 9 presents platelet transfusion recommendations for HELLP [

Table 9 presents platelet transfusion recommendations for HELLP [468] and [469], as platelet counts <10–20 × 109/L increase the risk of profound haemorrhage even with non-operative delivery [470]. The platelet count may decrease rapidly in HELLP, mandating frequent serial measurement of platelet count (within hours), depending on the clinical condition. Clinicians should be aware of the potential for delays when ordering platelets or other

blood products. Anti-D(Rho) sensitization can be prevented by anti-D prophylaxis (300 μg dose anti-D immune globulin) in Rh D negative women [470]. HELLP does not improve immediately after delivery [471], as most women’s platelet counts fall and liver enzymes rise until day two postpartum, usually improving GDC-0941 supplier by day four such that by day six (or within 3 days of the platelet nadir), the platelet count should be ⩾100 × 109/L. For HELLP, corticosteroids (dexamethasone more than betamethasone), especially if initiated before delivery, significantly improve platelet counts and other haematological and biochemical indices (ALT, AST, and LDH), but without a significant impact on major maternal or perinatal outcomes (death or severe morbidity) [472]. Regional

anaesthesia may be achieved more often with corticosteroids [473]. By incorporating dexamethasone into a local HELLP protocol (along with MgSO4 and antihypertensives), one centre noted less severe maternal morbidity and disease progression [474]. Women with progressive HELLP, particularly postpartum, may improve with plasma therapies effective for thrombotic thrombocytopoenic purpura (TTP) [475]. No RCTs were identified. Also, see ‘Timing of delivery’. 1. BP should be measured during the time of peak postpartum BP, at days three to six after delivery (III-B; Low/Strong). Hypertension may antedate delivery in up to 50% of women with postpartum hypertension. Women with pre-existing hypertension not requiring antihypertensives antenatally may require antihypertensives early in the puerperium [476]. Those at greatest

risk of postpartum oxyclozanide hypertension are those who delivered preterm, and, for multiparous women, those with higher urate levels [477] and [478]. Postpartum deterioration of maternal end-organ function occurs in up to 25%, usually in the early puerperium, especially with severe disease [479]. De novo postpartum hypertension is most common on days three to six [480]. It may be isolated or associated with preeclampsia-related end-organ dysfunction. Two thirds of women with postpartum preeclampsia had no antenatal HDP and their postpartum preeclampsia/eclampsia usually develops within days, but occasionally up to three weeks, after delivery [481]. There are no reliable data to guide whether or not antenatal antihypertensives should be continued postpartum, and which antihypertensive to choose.

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