Among pregnant women, the highest risk period for venous thromboembolism and pulmonary embolism in particular is during the postpartum period. Any prophylaxis against these events should be particularly targeted to postpartum women. Although the incidence of pulmonary embolism has decreased over time, the incidence of deep venous thrombosis remains unchanged, indicating the need to better identify pregnant women at increased risk.

One of the most serious presentations of preeclampsia is the HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. Treatment has generally been limited to supportive measures and management of complications, but recent clinical trials-which were not double-blind or placebo-controlled-suggest that dexamethasone may stabilize the disorder and even improve it in the antepartum period, maximizing postpartum recovery. The present randomized, double-blind, placebo-controlled trial enrolled 132 women, 60 of them pregnant and 72 puerperal, who met criteria for complete HELLP syndrome. They were randomly assigned to a treatment or placebo group and in the former case received 10 mg dexamethasone intravenously at 12-hour intervals until delivery and three further doses after delivery. The puerperal women received three doses of dexamethasone. All women received, in addition, magnesium sulfate intravenously and, when needed, an antihypertensive agent, initially nifedipine and subsequently clonidine or amlodipine if necessary to lower the diastolic blood pressure.Hospital time was less for women given dexamethasone, although not to a significant degree. The treatment and placebo groups were similar in the time needed to reach a platelet count exceeding 100,000/mm 3 . There also was no difference in the proportion of women reaching a lactate dehydrogenase level less than 600 U/L before discharge. Treatment did not hasten recovery in patients with an aspartate aminotransferase level less than 70 U/L before discharge. Urine output was comparable in the treatment and control groups. Three of four maternal deaths were in steroid-treated women. No substantial differences were evident when pregnant and puerperal women were analyzed separately.These findings do not support using dexamethasone to treat HELLP syndrome in preeclamptic women who are in late pregnancy or the early postpartum period. EDITORIAL COMMENT(The abstracted study is both well done and important. It is the sixth randomized study to address this issue and by far the best. It is four times as large as the previous largest trial, doubleblind and placebo-controlled (none of the prior ones were), and only women who met stringent criteria for the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome were enrolled. Additional strengths of this study include the fact that 132 of 144 eligible women participated, and the protocol was carried out with high fidelity. Participating women had serious disease. The average lactate dehydrogenase (LDH) concentration at randomization was over 2000 U/L, the average total bilirubin approximately 3.5 mg/mL, the average aspartate OBSTETRICS ABSTRACTIn Europe, as many as 2.5% of parturients have hepatitis C virus (HCV) infection, and estimates of mother-to-child transmission range from 3% up to 10%. The maternal load of HCV is probably the major determinant of transmission, but risk factors have not been precisely defined. This multicenter European prospective study, based on data provided by the European Ped...

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