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[Corticosteroid therapy for patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count)]
Filomena Nunes1, Ana Paula Campos, Teresa Avillez
1Serviço de Ginecologia/Obstetrícia, Hospital Garcia de Orta, Almada.
Insights
High-dose corticosteroid therapy, specifically dexamethasone, shows positive clinical and laboratory improvements in patients with HELLP syndrome. This treatment may lead to a longer time to delivery and improved symptoms and lab values without increasing maternal morbidity.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Pharmacology
Context:
- HELLP syndrome is a severe pregnancy complication.
- Effective management strategies for HELLP syndrome are crucial.
- Corticosteroids are used in obstetric practice, but their role in HELLP requires clarification.
Purpose:
- To evaluate the clinical and laboratory effects of high-dose corticosteroid therapy on HELLP syndrome.
- To compare outcomes between patients receiving dexamethasone and those not receiving it or receiving standard corticosteroid regimens.
- To assess the influence of dexamethasone on disease progression and maternal/perinatal outcomes.
Summary:
- A retrospective review compared 48 HELLP syndrome cases, with 35 receiving high-dose dexamethasone and 13 not.
- The dexamethasone group showed significant improvements in epigastric pain, platelet count, liver enzymes, and LDH.
- While the time to delivery was longer in the dexamethasone group, maternal morbidity and perinatal mortality were similar, with increased regional anesthesia use.
Impact:
- High-dose corticosteroid therapy demonstrates a positive influence on the clinical and laboratory course of HELLP syndrome.
- Dexamethasone treatment appears to stabilize HELLP syndrome, allowing for potentially improved maternal and fetal outcomes.
- This finding supports the consideration of high-dose corticosteroids as an adjunct therapy in managing HELLP syndrome.
Objective:
To evaluate the influence of the therapy with high-dose corticoids on the clinical and laboratory evolution of HELLP syndrome.
Study Design:
We reviewed all the cases of pregnancy complicated with HELLP, admitted to the Garcia de Orta Hospital from 1993 to 2000. We compared the patients without corticosteroid therapy or with a standard corticosteroid regimen for promotion of fetal lung maturation--group 1, with the patients who received dexamethasone (10 mg intramuscular every 12 hours)--group 2.
Results:
Out of 48 patients, 13 were included on group 1 and 35 on group 2. The time from admission to delivery was longer for the group on dexamethasone (3.7+/-4.5 days) compared to the group without (1.8+/-2.4). There was a significant improvement in the symptom of epigastric pain (P<0.05) and in the laboratory findings--platelets (P<0.000), liver enzymes (P<0.000) and lactic dehydrogenase (P<0.001), in the dexamethasone group. The number of caesarean deliverys was similar on both groups (group 1--46% and group 2--48%). The use of regional anesthetic techniques for delivery, was higher on group 2--66% (23 of 35) compared with group 1--15% (2 of 13), P=0.006. There was no significant difference in the maternal morbidity or number of blood transfusions. Perinatal mortality was associated with prematurity, and similar in the two groups.
Conclusions:
This study confirms the positive influence of the high-dose corticosteroid therapy on HELLP syndrome.
