BETTER MATERNAL OUTCOMES ARE ACHIEVED WITH DEXAMETHASONE THERAPY FOR POSTPARTUM HELLP (HEMOLYSIS, ELEVATED LIVER-ENZYMES, AND THROMBOCYTOPENIA) SYNDROME

OBJECTIVE: Our purpose was to determine whether the routine initiation of dexamethasone therapy in patients with postpartum HELLP (hemolysis , elevated liver enzymes, and thrombocytopenia) syndrome produces spec ific and general therapeutic benefits. STUDY DESIGN: In this retrospec tive, analytic study the puerperal courses of 43 women with postpartum HELLP syndrome who were treated with dexamethasone were compared with those of 237 similar patients who did not receive corticosteroids. De xamethasone 10 mg intravenously at 12-hour intervals was given until d isease remission was noted in treated patients, at which time up to tw o additional 5 mg intravenous doses were given at 12-hour intervals. R ESULTS: The two patient groups were similar in regard to mode of deliv ery, gestational age, parity, and frequency of eclampsia. Compared wit h control subjects, dexamethasone-treated postpartum patients were mor e ill with significantly higher (p < 0.05) admission mean arterial blo od pressure, higher serum uric acid level, and severe proteinuria. Dex amethasone administration was associated with a more rapid normalizati on of platelet counts and lactic dehydrogenase values. Most impressive was a clinically significant reduction of indicated transfusion and r espiratory therapy, invasive hemodynamic monitoring, infectious or ble eding-related morbidity, and length of postpartum hospital course. CON CLUSIONS: Patients who received dexamethasone for postpartum-onset HEL LP syndrome experienced a shorter disease course, faster recovery, les s morbidity, and less need for other interventionist therapy compared with patients with HELLP syndrome who did not receive dexamethasone.