Corticosteroids for HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome

Patient

At our monthly meeting on maternal morbidity we discussed a 31 year old woman at 35 weeks' gestation. She was admitted to the labour and delivery ward because of elevated blood pressure (155/90 mm Hg). Laboratory tests showed increased levels of aspartate aminotransferase and alanine aminotransferase in addition to proteinuria. Her platelet count was 68 000. She received no corticosteroids antepartum or post partum for HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome, and both she and her infant did well.

In recent months we had cared for other women with HELLP syndrome who were given corticosteroids on the recommendation of our obstetrical consultants (none were present at the meeting). This experience raised the issue of whether such patients benefit from corticosteroids. The family physicians, obstetricians, and nurse midwives at the meeting were unable to reach consensus on this topic, and those with opinions were unaware of supporting evidence. As our question remained unanswered, we decided to assess current evidence. In doing so we framed the question: “Among patients with HELLP syndrome, does the administration of corticosteroids improve maternal morbidity in terms of both laboratory and clinical parameters?”

Search

We searched Medline from 1966 to February 2004 using the key words “HELLP syndrome” (all subheadings) AND “corticosteroids” (which mapped to “adrenal cortex hormones”). Our search produced 36 citations. We reviewed the titles to determine which articles might answer …