PL109. Corticosteroids in the management of severe preeclampsia: What evidence?

Abstract

Introduction The fundamental premise that has governed the proposal relative to the use of corticosteroids for the purpose of disease modification in severe preeclampsia was that preeclampsia is a condition characterized by an inappropriate maternal systemic inflammatory response and possibly immune-mediated impairment in maternal-fetal communication, while corticosteroids have the capacity to exercise anti-inflammatory and immunosuppressive effects. Objective The presentation will review the evidence behind this proposal. The risks associated with such an approach, especially in fetuses manifesting growth restriction and umbilical artery absent end-diastolic flow, will also be discussed. Methods The literature published between 1990 and 2015 was searched for papers dealing with corticosteroids treatment for disease modification in preeclampsia and HELLP syndrome, using a combination of keywords including “HELLP syndrome”, “preeclampsia”, “corticosteroids” and “maternal and fetal outcomes”. The MEDLINE bibliographic database yielded studies heterogeneous as methodology including retrospective analyses, randomized trials, and meta-analyses. Published studies were assessed for quality according to Jadad’s quality assessment scale. Results On the basis of a critical interpretation of the available literature, we argue that corticosteroids administration, either antepartum or postpartum, does not improve the outcome of pregnancies affected by severe preeclampsia. Conclusion Until more convincing data become available, corticosteroids for disease modification in women with preeclampsia should not be used outside the setting of an approved investigational protocol. In antepartum HELLP syndrome, if a brief period (not to exceed 48 hours) of expectant management is elected to allow optimal exposure to corticosteroids strictly for fetal benefit, intensive surveillance of both mother and fetus is indicated.