Postpartum Dexamethasone for Women With Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) Syndrome: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

A combination of hemolysis, elevated liver enzymes, and low platelets—the HELLP syndrome—is one of the most severe forms of preeclampsia and one for which no definitive treatment is available. The use of corticosteroids has been proposed because of their ability to reduce platelet adhesion, limit platelet removal by the spleen, activate platelets, and exert a direct effect on the endothelium. In this prospective, randomized, double-blind, placebo-controlled trial,105 women with HELLP syndrome in the postpartum period were assigned to receive either 10 mg of dexamethasone or placebo solution by intravenous injection every 12 hours over 4 days. In addition, all patients received magnesium sulfate to prevent or treat eclamptic convulsions, and captopril to control hypertensive peaks exceeding 180 mm Hg systolic and/or 120 mm Hg diastolic. Baseline characteristics were similar in the 56 women given dexamethasone and the 49 receiving placebo. Complication rates also were similar in the 2 groups. Oliguria was the most frequent complication, followed by hemorrhage at a variety of sites. Acute renal failure occurred in 16% of steroid-treated women and 24.5% of the control group. The respective figures for acute pulmonary edema were 3.6% and 10.2%. No significant differences in either maternal morbidity or mortality were observed. Two steroid-treated patients (3.6%) and 2 placebo recipients (4.1%) died. The groups also were comparable with respect to time in hospital and the need for blood products. There were no significant group differences in the pattern of platelet recovery, levels of aspartate aminotransferase or lactate dehydrogenase, hemoglobin, or diuresis. The investigators conclude that these findings fail to support the routine use of dexamethasone following childbirth in women with HELLP syndrome.