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CENTERVIEW
EARLY HELLP by Jack Mazurak
A recently released University of Mississippi Medical Center study of 190
pregnant women with HELLP Syndrome, a severe form of preeclampsia, further
underscores the effectiveness of a locally formulated treatment called the Mississippi
Protocol.
“What this paper shows is that by identifying mothers who are moving toward
HELLP and starting the protocol early on – starting steroids and controlling systolic
blood pressure – helps to speed the mother’s recovery. It slows and can stop the
Co-authors on a study of UMMC patients with HEllP Syndrome are, from left,
ob/gyn fellow Dr. Justin Brewer, clinical research assistant Pam Blake and Dr. Jim Martin,
professor of obstetrics and gynecology and the study’s principal investigator.
disease progression,” said Dr. Jim Martin, professor of obstetrics-gynecology and the
study’s principal investigator.
HELLP Syndrome is an acronym for the symptoms defining it – hemolysis, or the
breaking down of red blood cells, elevated liver enzymes and low blood platelet count.
While it causes few maternal deaths in developed countries, it can disrupt renal function,
cause liver hematomas or hemorrhages, strokes and cardiovascular problems.
OF the 190 wOMeN studied from 2000-07, Martin and his team saw no
maternal deaths, strokes or hemorrhages develop. Only two women suffered cardiovascular
complications.
Of 163 patients who were below class 1 status in HELLP Syndrome when doctors
began the protocol, only 39 women – 24 percent – progressed to class 1. Only
18.2 percent of class 1 and 2.4 percent of the less-acute class 2 patients subsequently
developed major maternal morbidity.
The journal “Hypertension in Pregnancy” released an online abstract of the
study in January. Print publication is expected this spring.
“This is the first study to show that using such a protocol, if initiated early enough
in the disease process, can slow down disease and minimize excess morbidity,” said
Martin, director of maternal-fetal medicine. “The protocol doesn’t change the fact that
the patient came in with HELLP. It won’t reverse it, but it will slow or stop it.”
Traditionally doctors give preeclamptic mothers corticosteroids, such as Decadron,
on the baby’s behalf. Steroids speed fetal lung development and allow an earlier
delivery. Once delivered, preeclampsia usually subsides.
CEnTErVIEW | February 7, 2011
Martin and his team developed the Mississippi Protocol throughout the
1990s. When they realized the effect of steroids on the mother – slowing and
sometimes stopping the advance of HELLP – they made it a key aspect of their
protocol.
the MIssIssIppI prOtOCOl is still considered experimental, not the
standard of care but certainly within it, Martin said.
“Not everybody in the profession uses it because there’s been no large, randomized
controlled study that proves it effective,” he said. “Still,
we’ve been down this treatment road so long now, with such
good results, I wouldn’t want to expose those moms to anything
but.”
The National Heart, Lung and Blood Institute decided
against funding such a study that Martin and his team proposed
in the late 1990s.
“A large randomized study would be a tremendous undertaking
and quite expensive,” Martin said. “We had 26 centers
across the country involved and an independent data-monitoring
center and a proposed 1,500 patients.”
The somewhat rare nature of HELLP and that it’s often misdiagnosed
further complicates prospects for a nationwide study.
UMMC sees 30-45 HELLP patients annually, more than average
for hospitals because Mississippi’s population is the nation’s
unhealthiest. And with UMMC’s expertise in preeclampsia and
its standing as the state’s only academic health science center,
many preeclamptic mothers get referred to the Medical Center
from elsewhere in the state.
the COMpleted study of 190 women was funded by
Department of Obstetrics and Gynecology revenue. Co-authors
include Dr. Michelle Owens, Dr. Sharon Keiser, Dr. Marc
Parrish, Dr. Kiran Tam Tam and Dr. Justin Brewer. Co-authors
Julie Cushman and Pam Blake, clinical research coordinator,
along with Warren May, professor in the Center of Biostatistics and Bioinformatics,
assisted with gathering and managing the study’s data.
The next step, Martin said, and one which Owens is already working on, is
figuring out just why the steroids work for the mothers.
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Study indicates Mississippi Protocol
effective in treating preeclamptic women
Dr. James Martin and his team developed the Mississippi Protocol, a
treatment course for HELLP Syndrome, throughout the 1990s. Its
precepts are:
Early identification of preeclamptic women who may be developing
HELLP Syndrome;
Administer corticosteroids quickly if there’s epigastric pain, eclampsia
or rapid HELLP progression;
If not, monitor platelet counts and lactic dehydrogenase (LDH) and
aspartate aminotransferase (AST) levels;
Monitor systolic blood pressure, treat with antihypertensive drugs
if above 160; and
Administer corticosteroids with decreases in platelet count
and LDH or increases in AST.