Hemolysis, elevated liver
enzymes and low platelets (
HELLP) syndrome is a severe form of
pre-eclampsia.
Pre-eclampsia is a multi-system disease of pregnancy associated with an increase in blood pressure and increased perinatal and maternal morbidity and mortality. Eighty per cent of women with
HELLP syndrome present before term. There are suggestions from observational studies that
steroid treatment in
HELLP syndrome may improve disordered maternal hematological and biochemical features and perhaps perinatal mortality and morbidity.
OBJECTIVES: We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2003). We scanned lists of references from review articles and primary studies.
SELECTION CRITERIA: The two authors independently applied inclusion criteria, assessed trial quality and extracted relevant data.
MAIN RESULTS: Of the five studies reviewed (n = 170), three were conducted antepartum and two postpartum. Four of the studies randomised participants to standard
therapy or
dexamethasone. One study compared
dexamethasone with
betamethasone.
Dexamethasone versus control There were no significant differences in the primary outcomes of maternal mortality and morbidity due to
placental abruption, pulmonary oedema and liver
hematoma or
rupture. Of the secondary maternal outcomes, there was a tendency to a greater platelet count increase over 48 hours, statistically significantly less mean number of
hospital stay days (weighted mean difference (WMD) -4.50, 95% confidence interval (CI) -7.13 to -1.87), mean interval (hours) to delivery (41 +/- 15) versus (15 +/- 4.5) (p = 0.0068) in favour of women allocated to
dexamethasone.There were no significant differences in perinatal mortality or morbidity due to
respiratory distress syndrome, need for ventilatory support,
intracerebral hemorrhage,
necrotizing enterocolitis and a five minute Apgar less than seven. The mean
birthweight was significantly greater in the group allocated to
dexamethasone (WMD 247.00, 95% CI 65.41 to 428.59).
Dexamethasone versus
betamethasone There were no significant differences in all the maternal and perinatal mortality and in primary morbidity outcomes.Women randomised to
dexamethasone fared significantly better for:
oliguria, mean arterial pressure, mean increase in platelet count, mean increase in urinary output and liver
enzyme elevations.
AUTHORS' CONCLUSIONS: There is insufficient evidence to determine whether adjunctive
steroid use in
HELLP syndrome decreases maternal and perinatal mortality, major maternal and perinatal morbidity.