Corticosteroid therapy for patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)

Abstract

To evaluate the influence of the therapy with high-dose corticoids on the clinical and laboratory evolution of HELLP syndrome. We reviewed all the cases of pregnancy complicated with HELLP, admitted to the Garcia de Orta Hospital from 1993 to 2000. We compared the patients without corticosteroid therapy or with a standard corticosteroid regimen for promotion of fetal lung maturation--group 1, with the patients who received dexamethasone (10 mg intramuscular every 12 hours)--group 2. Out of 48 patients, 13 were included on group 1 and 35 on group 2. The time from admission to delivery was longer for the group on dexamethasone (3.7+/-4.5 days) compared to the group without (1.8+/-2.4). There was a significant improvement in the symptom of epigastric pain (P<0.05) and in the laboratory findings--platelets (P<0.000), liver enzymes (P<0.000) and lactic dehydrogenase (P<0.001), in the dexamethasone group. The number of caesarean deliverys was similar on both groups (group 1--46% and group 2--48%). The use of regional anesthetic techniques for delivery, was higher on group 2--66% (23 of 35) compared with group 1--15% (2 of 13), P=0.006. There was no significant difference in the maternal morbidity or number of blood transfusions. Perinatal mortality was associated with prematurity, and similar in the two groups. This study confirms the positive influence of the high-dose corticosteroid therapy on HELLP syndrome.