Maternal benefit of high-dose intravenous corticosteroid therapy for HELLP syndrome

OBJECTIVE: We compared maternal outcomes for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome treated with or without high-dose,corticosteroids to ameliorate maternal disease. STUDY DESIGN: An analysis of data for patients with HELLP syndrome (platelets, less than or equal to100,000/muL; lactate dehydrogenase level, 600 IU/L; aspartate aminotransferase and/or alanine aminotransferase level, greater than or equal to70 IU/L) who were treated during the 7-year epochs before and after the clinical trials in 1992 and 1993 demonstrated maternal benefit with high-dose dexamethasone. RESULTS: Corticosteroid use increased from 16% (39/246 patients) for fetal indication from 1985 to 1991 to 90% (205/228 patients) for maternal-fetal indications from 1994 to 2000. Significantly reduced composite maternal disease from 1994 to 2000 was evidenced by improvements in laboratory parameters, disease progression to class 1 HELLP syndrome, the degree of hypertension, the need for anti hypertensive therapy, the use of transfusion, and the presence of maternal morbidity (P < .05). Indices of postpartum recovery also were shortened significantly (P < .001). CONCLUSION: Routine early initiation of high-dose intravenous corticosteroids for patients with HELLP syndrome significantly lessened maternal disease, reduced maternal morbidity, and expedited recovery.