A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome

OBJECTIVE: This study was undertaken to determine whether dexamethasone or betamethasone is superior for the antepartum treatment of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: This prospective, randomized, clinical investigation compared intravenously administered dexamethasone and intramuscularly administered betamethasone in the treatment of gravid women with HELLP syndrome. Efficac y end points included laboratory values (platelet count, lactate dehydrogen ase activity, aspartate aminotransferase activity) and clinical parameters (mean arterial pressure, urinary output). RESULTS: Forty patients were enrolled in the study, 19 in the dexamethasone arm and 21 in the betamethasone arm. The adjusted time-averaged changes fr om baseline were significant for aspartate aminotransferase activity (dexam ethasone, -20.4 +/- 9.6 U/L; betamethasone, 9.9 +/- 8.9 U/L; P = .029), mea n arterial pressure (dexamethasone, -15.6 +/- 1.4 mm Hg; betamethasone, -8. 1 +/- 1.4 mm Hg; P < .001), and urinary output (dexamethasone, 12.9 +/- 8.6 mL/h; betamethasone, -11.9 +/- 8.2 mL/h; P = .043). CONCLUSION: Intravenously administered dexamethasone appears to be more eff ective than intramuscularly adminstered betamethasone for the antepartum tr eatment of mothers with HELLP syndrome.