P99. Use of high dose cortisosteroids in HELLP syndrome

Abstract

Introduction Several reports have shown high levels of pro-inflammatory agents in maternal plasma in HELLP syndrome. Corticosteroids, as potent anti-inflammatory agents are maybe able to ameliorate inflammatory response and thereby positively influence the deterioration of disease. Even if several studies have showed a beneficial effect of corticosteroids in patients with HELLP syndrome, the possible effect of corticosteroids in HELLP syndrome is still under discussion. Objectives Corticosteroids in the management of HELLP syndrome has been introduced to our department in 2006. The therapeutic concept includes high-dose prednisolone administered one to three times. Background of this therapy is maximum impact; high dose; connected to the minimum of negative effects; no adrenal suppression and minimum of placental transfer. To evaluate the corticosteroid use at our department we analyzed the HELLP syndrome cases of the last 10 years. Methods Maternal and neonatal outcome in HELLP syndrome cases was analyzed in a retrospective study between 1st January 2005 and 31st December 2014. Data were presented in absolute numbers and percentages; statistic was performed using Chi square, Fisher’s exact test, independent T test and ANOVA calculation. A two-sided p-value of less than 0.05 was considered as significant. Results Pregnancies complicated by HELLP syndrome (n = 91) were divided in 3 groups: (1) PRED treated by high prednisolone administered one to three times (n = 61, 67.1%), (2) NO, receiving no corticosteroids (n = 18, 19.7%) and (3) MIX, received more than three doses and different types of corticosteroids (n = 12, 13.2%). The characteristics of the MIX group were different compared to the other groups: earlier gestational age at diagnosis, additional diseases and reasons with need of corticosteroid administration. The NO and PRED groups were similar regarding group distribution. Comparing NO with PRED group, there was a tendency (n.s.) to shorter intensive care and hospitalization times, decreased incidence of cesarean section and increased ratio of complete fetal lung maturation cycle in the PRED group. There were no differences between maternal morbidity or neonatal asphyxia. Conclusion The management of HELLP syndrome with a high dose prednisolone should be evaluated in a further prospective study. However, it seems that the use of high dose corticosteroids could improve the outcome of pregnancies complicated by HELLP syndrome. Adjustment of the therapy regime may be necessary in cases with very early HELLP syndrome before 25th week of gestation or additional morbidity. Due to the low placental transpass of prednisolone it can be advantageous over other corticosteroids in the use as HELLP syndrome therapy.