Corticosteroids for the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP): what evidence?

The fundamental premise that has governed the proposal relative to the use of corticosteroids for the purpose of disease modification in Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) syndrome was that pre-eclampsia is a condition characterized by an inappropriate maternal systemic inflammatory response and possibly immune-mediated impairment in maternal-fetal communication, while corticosteroids have the capacity to exercise anti-inflammatory and immunosuppressive effects. The present article reviews the evidence behind this proposal, concluding that corticosteroids administration, either antepartum or postpartum, does not improve the outcome of pregnancies affected by HELLP syndrome. The risks associated with such an approach, especially in fetuses manifesting growth restriction and absent end-diastolic flow, are also discussed. The literature published in English between 1990 and 2006 was searched for papers dealing with corticosteroids treatment for disease modification in pre-eclampsia and HELLP syndrome, using a combination of keywords including ''HELLP syndrome '', ''pre-eclampsia'', ''corticosteroids'', and ''maternal and fetal outcomes''. The MEDLINE bibliographic database yielded 9 studies relevant to this topic, including one retrospective analysis, 7 randomized trials, and one meta-analysis. Until more convincing data become available, corticosteroids for disease modification in women with HELLP syndrome should not be used outside the setting of an approved investigational protocol.