Microcirculation in women with severe pre‐eclampsia and HELLP syndrome: a case–control study

Abstract

Objective To compare microcirculatory perfusion in women with severe pre-eclampsia against that in healthy pregnant women, and secondly in women with severe pre-eclampsia with or without HELLP syndrome (haemolysis, elevated liver enzymes, and low platelets).Design Case-control study.Setting University Hospital Rotterdam, the Netherlands.Population Twenty-three women with severe pre-eclampsia and 23 healthy pregnant controls, matched for maternal and gestational age. Out of the 23 women with severe pre-eclampsia, ten presented with HELLP syndrome.Methods Microcirculation was analysed sublingually by a non-invasive sidestream dark-field imaging device (SDF).Main outcome measures Perfused vessel density (PVD), microcirculatory flow index (MFI), and heterogeneity index (HI) were calculated for both small vessels (∅ < 20 lm; capillaries) and non-small vessels (∅ > 20 lm; venules and arterioles).Results There were no significant differences between women with severe pre-eclampsia and healthy controls. Women with pre-eclampsia and HELLP syndrome showed a reduced PVD (P = 0.045), MFI (P = 0.008), and increased HI (P = 0.002) for small vessels, as compared with women with pre-eclampsia but without HELLP syndrome.Conclusions Sidestream dark-field is a novel, promising technique in obstetrics that permits the non-invasive evaluation of microcirculation. We did not observe major differences in sublingual microcirculatory perfusion between women with severe pre-eclampsia and healthy pregnant controls. In women with severe pre-eclampsia, the presence of HELLP syndrome is characterised by impaired capillary perfusion.Keywords Capillary, HELLP syndrome, microcirculation, microcirculatory perfusion, pre-eclampsia, sidestream dark-field imaging.Please cite this paper as: Cornette J, Herzog E, Buijs EAB, Duvekot JJ, Rizopoulos D, Hop WCJ, Tibboel D, Steegers EAP. Microcirculation in women with severe pre-eclampsia and HELLP syndrome: a case-control study.

Hemodynamic effects of intravenous nicardipine in severely pre‐eclamptic women with a hypertensive crisis

“…The lack of changes might be attributed to the fact that baseline microcirculatory perfusion before nicardipine was relatively normal in our population. We demonstrated previously that sublingual microcirculatory perfusion is disturbed mainly in severe PE with concurrent HELLP syndrome 35 . Only four women in this study had an episode of HELLP syndrome at the time of the microcirculatory measurements.…”

“…Statistics were performed with IBM SPSS Statistics v. 20.0 (IBM, Armonk, NY, USA). Based on previous results and clinical relevance, CO, TVR, mitral E/A ratio, uterine artery PI, CPR and capillary HI were considered primary outcome parameters. Measurements obtained before and after nicardipine were compared using non‐parametric Wilcoxon signed‐ranks test.…”

Reproducibility of Microvascular Vessel Density Analysis in Sidestream Dark‐Field‐Derived Images of Healthy Term Newborns

“…To our knowledge, this is the first study reporting on interobserver reproducibility for the TVD and PVD in SDF clips using Bland–Altman plots and ICC in this patient group. Previous studies in healthy and (critically) ill adult patients have already established good interobserver variability in the sublingual area . A study by Buijs et al .…”

Author's reply re: Microcirculation in women with severe pre‐eclampsia and HELLP syndrome: a case control study

“…We and others have previously demonstrated microcirculatory perfusion problems in women with HELLP . While more research is needed on the subject, microvascular assessment has the potential to assist in predicting prognosis and in guiding treatment.…”