Dexamethasone-facilitated postponement of delivery of an extremely preterm pregnancy complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelets.
OBJECTIVE
Patients with severe preeclampsia and the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome) are at increased risk for perinatal and maternal morbidity, especially in very preterm gestations. When this condition affects a pregnancy on the cusp of viability, a therapeutic intervention to prolong gestation without undue risk to the mother or fetus could be beneficial.


METHODS
A single case report and review of the literature.


RESULTS
We report a patient with HELLP syndrome in whom antenatal administration of high-dose dexamethasone helped achieve disease stabilization and delivery postponement for 9 days of a very preterm fetus estimated to weight less than 600 g. Both mother and infant did well postpartum.


CONCLUSIONS
Administration of antenatal high-dose dexamethasone can be used in carefully selected preterm patients with HELLP syndrome to delay delivery while in utero fetal maturation is accelerated and the maternal condition is optimized. This can be beneficial in carefully selected pregnancies without apparent adverse maternal or perinatal impact.
O'Boyle
J D
JD
Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, CA, USA.
Magann
E F
EF
Waxman
E
E
Martin
J N
JN
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D017359:HELLP Syndrome / Q000097:blood / Q000150:complications*; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007752:Obstetric Labor, Premature / Q000150:complications* / Q000517:prevention & control*; D010976:Platelet Count; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D007770:L-Lactate Dehydrogenase