[Treatment of severe preeclampsia and HELLP syndrome]

Severe preeclampsia and HELLP syndrome are still one of the leading causes of maternal and perinatal morbidity and mortality. The current definitions of the diseases should be considered before treatment. The timely allocation to a perinatal center and an intensive monitoring of mother and child after admission are mandatory for successful management of these patients. The aim of therapy is immediate stabilization of the mother's condition by means of anticonvulsive prophylaxis with intravenous magnesium sulphate, well-controlled reduction of blood pressure by the administration of urapidil or nifedipine, controlled volume expansion and an adequate treatment of coagulation disorders by giving fresh frozen plasma (not heparin). Immediate delivery is the method of choice in cases of severe preeclampsia/HELLP syndrome > or = 34 weeks' gestations; we prefer cesarean section in patients with an unripe cervix and the full-blown picture of HELLP syndrome. In patients < 34 weeks' gestation expectant management is generally possible under intensive monitoring of the mother and the fetus. Maternal and fetal indications for immediate termination of pregnancy should be considered carefully. The systemic application of corticosteroids is a promising approach to prolong pregnancy. During the past decade the increasing awareness of obstetricians and other disciplines have led to a significant reduction of maternal mortality (< 1 %) and perinatal mortality (9.4-16.2 %) in cases of HELLP syndrome, in particular in the West European countries.