Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy.
BACKGROUND
Pre-eclampsia is a relatively common complication of pregnancy. HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome is a severe manifestation of pre-eclampsia with significant morbidity and mortality for pregnant women and their children. Corticosteroids are commonly used in the treatment of HELLP syndrome in the belief that they improve outcomes.


OBJECTIVE
To determine the effects of corticosteroids on women with HELLP syndrome and their children.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2010).


METHODS
Randomized controlled trials comparing any corticosteroid with placebo, no treatment, or other drug; or comparing one corticosteroid with another corticosteroid or dosage in women with HELLP syndrome.


METHODS
Two review authors assessed trial quality and extracted data independently.


RESULTS
Eleven trials (550 women) compared corticosteroids with placebo or no treatment. There was no difference in the risk of maternal death (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.28 to 3.21), maternal death or severe maternal morbidity (RR 0.27, 95% CI 0.03 to 2.12), or perinatal/infant death (RR 0.64, 95% CI 0.21 to 1.97). The only clear effect of treatment on individual outcomes was improved platelet count (standardized mean difference (SMD) 0.67, 95% CI 0.24 to 1.10). The effect on platelet count was strongest for women who commenced treatment antenatally (SMD 0.80, 95% CI 0.25 to 1.35).Two trials (76 women) compared dexamethasone with betamethasone. There was no clear evidence of a difference between groups in respect to perinatal/infant death (RR 0.95, 95% CI 0.15 to 6.17) or severe perinatal/infant morbidity or death (RR 0.64, 95% CI 0.27 to 1.48). Maternal death and severe maternal morbidity were not reported. In respect to platelet count, dexamethasone was superior to betamethasone (MD 6.02, 95% CI 1.71 to 10.33), both when treatment was commenced antenatally (MD 8.10, 95% CI 6.23 to 9.97) and postnatally (MD 3.70, 95% CI 0.96 to 6.44).


CONCLUSIONS
There was no clear evidence of any effect of corticosteroids on substantive clinical outcomes. Those receiving steroids showed significantly greater improvement in platelet counts which was greater for those receiving dexamethasone than those receiving betamethasone. There is to date insufficient evidence of benefits in terms of substantive clinical outcomes to support the routine use of steroids for the management of HELLP. The use of corticosteroids may be justified in clinical situations in which increased rate of recovery in platelet count is considered clinically worthwhile.
Woudstra
Douglas M
DM
Department of Obstetrics and Gynaecology, University of Alberta, 13619 - 108 Avenue, Edmonton, Alberta, Canada, T5M 2C7.
Chandra
Sue
S
Hofmeyr
G Justus
GJ
Dowswell
Therese
T
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001623:Betamethasone / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D017359:HELLP Syndrome / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008428:Maternal Mortality; D054238:Perinatal Mortality; D010976:Platelet Count; D011239:Prednisolone / Q000627:therapeutic use; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
D000305:Adrenal Cortex Hormones; D003907:Dexamethasone; D001623:Betamethasone; D011239:Prednisolone
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