Report from the 27th Annual SMFM Meeting - 2007

Hey guys! I am really still alive. I have been traveling and now am in San Francisco for the 27th Annual Meeting of the Society for Maternal-Fetal Medicine. This is the first access to the internet that I have had in the past week. Yesterday, I attended an all-day course on “Suggested Guidelines for the Evaluation and Management of High-Risk Pregnancy Conditions.” In my next few posts, I will present some of the highlights and some of the disappointments from the course presentations as well as some of the new and interesting information that is presented in the plenary and poster sessions over the next several days:

• Dr. John T. Repke, Professor and Chair of OB/GYN at Penn State talked about “An evidence based approach to the management of mild and severe preeclampsia.” Great talk, but not much new information.

• We still do not know what causes preeclampsia, although in their various forms, hypertensive disorders of pregnancy account for 17.6% of all maternal deaths in the U.S.

• We still have no good screening test to define which women are at risk for preeclampsia, although we know many of the underlying conditions (chronic hypertension; kidney disease; autoimmune disorders; pregestational diabetes; obesity, etc.) that put women ‘at risk’ for developing it.

• Many forms of ‘empiric therapy’ have been tried to reduce the risk, but none have proven efficacy (e.g. low-dose aspirin; fish oil; zinc; calcium) and some are not only ineffective, but may actually be harmful (high-dose vitamin C and E supplementation).

• Despite the ‘bad press’ magnesium sulfate has received for management of preterm labor, it remains the ‘treatment of choice’ to prevent seizures associated with preeclampsia and to stabilize the patient in preparation for delivery, although its use in ‘mild preeclampsia’ is still of uncertain value.

• Expectant management (rather than immediate delivery) of women, even with severe preeclampsia, offers the best option for improving neonatal outcome, especially with early onset disease (24-25 weeks’), as long as maternal condition is stable and the baby does not appear to be compromised. Frequent assessment of both mother and baby is necessary under these circumstances since either/both can deteriorate rapidly once the condition begins to worsen.

• Women with severe preeclampsia associated with thrombocytopenia (low platelets) may benefit in the antepartum period by administration of a steroid (dexamethasone), but the primary advantage to therapy may only be that the platelet count can be raised to a level that bleeding risk is low and the anesthesiologist feels comfortable in administering a regional anesthetic (epidural or spinal) during labor or for cesarean delivery.

Women who develop preeclampsia are at life-long risk for hypertension, stroke, atherosclerotic cardiovascular disease, and possibly thromboembolic (blood clot) disorders and should be counseled regarding approaches to risk reduction during and after their pregnancies.

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