Impact of Postpartum Dexamethasone on Postpartum Disease Stabilization in Women with HELLP Syndrome

Abstract

OBJECTIVE: To investigate the impact of postpartum corticosteroid therapy on maternal disease in women with HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome.

STUDY DESIGN: Thirty-eight patients diagnosed with HELLP syndrome were randomly assigned to treatment (n= 19) and control (n=19) groups. Patients in the treatment group were administered dexamethasone 8 mg, 4 mg and 2 mg IV twice daily, on the postoperative days 1, 2 and 3 consecutively. The first dose was given immediately postpartum. Mean arterial pressure, platelet count , aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels were determined every 6 hours. Duration of intensive care and urinary output were also investigated.

RESULTS: Relative to the control group, the mean arterial pressure became significantly decreased at 42 hours in the steroid-treated group (p = 0.0035), the platelet count increased significantly by 24 hours (p<0.05), and AST and ALT decreased significantly by 24 and 18 hours respectively (p=0.02 and p = 0.01, respectively). Treatment group had higher mean platelet count for all time intervals and the difference between the groups was significant after the postpartum 42nd hour (p=0.03).

CONCLUSION: We observed a rapid resolution of the laboratory and clinical parameters in patients with HELLP syndrome treated with corticosteroids postpartum. We postulate that use of this therapeutic approach could result in reduced overall maternal morbidity and mortality, shorter intensive-care unit stay, with reduced medical care costs.