Choice of anti-hypertensive treatment in HELLP syndrome at ehu Oran

Abstract

In Africa and Asia, nearly 10% of maternal deaths are associated with hypertensive disorders during pregnancy. Among the hypertensive disorders, HELLP syndrome (Hemolysis Elevated Liver Enzymes, Low Platelets: HS) represents a significant cause of severe morbidity and long-term disability. Our goal was to evaluate the management of antihypertensive treatment in HS syndrome. Our prospective, monocentric study included patient with a HS between January 2013 and December 2016. Our protocol was based on the antihypertensive molecules available in our institution administered orally: alfa methyl-dopa, nicardipine and acebutolol and intravenously: most often nicardipine and magnesium sulfate when pre-eclampsia was diagnosed. One hundred and sixty-five patients with HS were admitted; mean age: 32 ± 6.33 years old, the average parity was 2 ± 1, the average term for onset of pre-partum HS was 32 weeks of amenorrhea. At admission, 112 patients (68%) had epigastric pain in the upper right thoracic quadrant; severe hypertension with arterial pressure values > 160/110 mmHg was found in 116 patients (70.3%), headache in 83 patients (50%), visual disturbances in 27 (16.4%), confusion and hyper-reflexivity in 43 patients (26.1%). Magnesium sulfate was used in 68 patients. 96 patients received nicardipine alone intravenously. The combination of magnesium sulfate and nicardipine was performed in 27 patients, without significant deleterious hemodynamic or respiratory side effects. The management of hypertension was done according to a codified protocol with molecules available in each Maghreb establishment; it requires deep involvement of the paramedical staff.