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.


METHODS
An analysis of data for patients with HELLP syndrome (platelets, <or=100,000/microL; lactate dehydrogenase level, >or=600 IU/L; aspartate aminotransferase and/or alanine aminotransferase level, >or=70 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 antihypertensive therapy, the use of transfusion, and the presence of maternal morbidity (P<.05). Indices of postpartum recovery also were shortened significantly (P<.001).


CONCLUSIONS
Routine early initiation of high-dose intravenous corticosteroids for patients with HELLP syndrome significantly lessened maternal disease, reduced maternal morbidity, and expedited recovery.
Martin
James N
JN
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
Thigpen
Brad D
BD
Rose
Carl H
CH
Cushman
Julie
J
Moore
Amanda
A
May
Warren L
WL
D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D001623:Betamethasone / Q000008:administration & dosage; D003345:Corticosterone / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D017359:HELLP Syndrome / Q000188:drug therapy*; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D007275:Injections, Intravenous; D007770:L-Lactate Dehydrogenase / Q000097:blood; D010976:Platelet Count; D011247:Pregnancy
D000959:Antihypertensive Agents; D005938:Glucocorticoids; D006830:Hydralazine; D003907:Dexamethasone; D001623:Betamethasone; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003345:Corticosterone