Expectant management of HELLP: prednisolone cuts exacerbations.(Obstetrics)

VIENNA -- Prolonged prednisolone administration reduces the risk of HELLP exacerbations in women undergoing expectant management remote from term, Pieter van Runnard Heimel, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Previous studies have demonstrated a beneficial effect of corticosteroids during expectant management in women with early-onset preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Most of these studies, however, have not looked at antepartum treatment for longer than 48 hours, said Dr. Heimel of the department of perinatology and gynecology at the University Medical Center, Utrecht, the Netherlands.

Of 31 women who developed HELLP syndrome before 30 weeks' gestation and were being managed expectantly, 15 were given 50 mg intravenous prednisolone twice daily, while the other 16 received intravenous placebo. The two groups did not differ in maternal age, blood pressure, or worst laboratory values.

Delivery was postponed for about a week in both groups, and the mean interval between entry and delivery--6.9 days with prednisolone versus 8.0 days with placebo--was not significantly different. However, HELLP exacerbations occurred in just 6 prednisone patients, compared with 13 in the placebo ...