Expectant Management of HELLP: Prednisolone Cuts Exacerbations


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 group, a significant 50% relative risk reduction.

The number needed to treat to prevent one recurrent exacerbation, 2.4, was also significant, Dr. Heimel reported at the meeting.

Time to recovery of normal lab values differed significantly for platelets (1.7 days with prednisone vs. 6.2 days for placebo), but not for liver enzyme levels. There were no significant differences in cesarean section rates (15 in the prednisone group and 14 in the placebo group) or in fetal or maternal indications for cesarean section.

There were three maternal complications—liver hematoma, liver rupture, and liver rupture/maternal death—all in the placebo group.

Mean gestational age and birth weight were not significantly different between the two groups.

Four perinatal deaths occurred in the placebo group; two were fetal demise, and two were in newborns within the first week of life. Three infants in the prednisolone group died within the first year of life.

Ten infants from each group were still alive at 24 months. Of those, two from the prednisolone group had head circumferences less than 2 standard deviations below normal, while three from the prednisolone group and four from the placebo group had other abnormalities, according to Dr. Heimel.

Next Article: