Objectives: To evaluate the effect of prolonged administration of high-dose prednisolone on early onset HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome during expectant management. Study design: A randomized, double-blind trial was performed in 31 pregnant women with HELLP syndrome with an onset before 30 weeks gestation. Patients received either 50 mg prednisolone or placebo intravenously twice a day. Primary outcome measures were the entry-to-delivery interval and the number of recurrent HELLP exacerbations in the antepartum period. Results: Serious maternal morbidity was considerable, in particular in the placebo group where even on maternal occurred as a consequence of liver rupture. The mean entry-delivery interval did not differ between the prednisolone group (6.9 days) and the placebo group (8.0 days). However, patients in the prednisolone group had a significant lower risk of a recurrent HELLP exacerbation after the initial crisis had subsided, as compared to patients in the placebo group (HR 0.3, with 95% CI 0.3-0.9). Platelet count recovered faster in the prednisolone group as compared to the placebo group (mean 1.7 days versus 6.2 days, P < 0.01). Conclusions: HELLP syndrome remote from term causes high risk for serious maternal morbidity and mortality. When expectant management is pursued in selected patients with a HELLP syndrome remote from term, prolonged administration of prednisolone reduces the risk of recurrent HELLP syndrome exacerbations.

, , ,
doi.org/10.1016/j.ejogrb.2005.11.041, hdl.handle.net/1765/71471
European Journal of Obstetrics & Gynecology and Reproductive Biology
Department of Gynaecology & Obstetrics

Van Runnard Heimel, P., Huisjes, A., Franx, A., Koopman, C., Bots, M., & Bruinse, H. (2006). A randomised placebo-controlled trial of prolonged prednisolone administration to patients with HELLP syndrome remote from term. European Journal of Obstetrics & Gynecology and Reproductive Biology, 128(1-2), 187–193. doi:10.1016/j.ejogrb.2005.11.041