From the Guidelines
HELLP syndrome management requires prompt recognition and treatment to prevent maternal and fetal complications, with the definitive treatment being delivery of the fetus, regardless of gestational age, especially when maternal condition is deteriorating. The initial management includes stabilization with intravenous magnesium sulfate for seizure prophylaxis, antihypertensive therapy to maintain blood pressure below 160/110 mmHg, and corticosteroids if less than 34 weeks gestation to accelerate fetal lung maturity 1.
Key Management Strategies
- Stabilization with intravenous magnesium sulfate (4-6g loading dose followed by 1-2g/hour continuous infusion) for seizure prophylaxis
- Antihypertensive therapy with labetalol (20-80mg IV every 10-20 minutes) or hydralazine (5-10mg IV every 20 minutes) to maintain blood pressure below 160/110 mmHg
- Corticosteroids (betamethasone 12mg IM, two doses 24 hours apart) if less than 34 weeks gestation to accelerate fetal lung maturity
- Blood products should be administered as needed: platelets for counts below 20,000/μL or before cesarean delivery if below 50,000/μL, and fresh frozen plasma for coagulopathy 1
Monitoring and Anaesthetic Considerations
- Close monitoring of maternal laboratory values (complete blood count, liver enzymes, coagulation studies) every 6-12 hours is essential
- A urinary catheter should be passed for hourly monitoring of urinary output, and a balloon-tipped pulmonary artery catheter or central venous catheter is indicated in critically ill patients for fluid management 1
- The choice of anaesthetic technique depends on the individual anaesthetist, with propofol being a logical choice for induction of anaesthesia due to its minimal hepatic or renal metabolism 1
Postpartum Care
- Postpartum, most patients show laboratory improvement within 48 hours, but continued surveillance is necessary as some may deteriorate before improving 1
- The goal of management is to prevent maternal and fetal complications, with a focus on prompt delivery and stabilization of the mother.
From the Research
HELLP Syndrome Management
- The mainstay of treatment for HELLP syndrome involves maternal stabilization and timely delivery 2.
- Various treatment strategies have been attempted to decrease the morbidity and mortality of HELLP, including the maternal use of corticosteroids, plasma exchange, and low molecular weight heparin 2.
- Conservative treatment (> 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation 3, 4.
- Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the fetal and/or maternal conditions deteriorate 3, 4, 5.
- Vaginal delivery is preferable, but if the cervix is unfavorable, it is reasonable to induce cervical ripening and then labor 3.
Treatment Options
- Corticosteroids may be used for fetal lung maturation in gestational ages between 24 and 34 weeks, but their clinical value in maternal HELLP syndrome is uncertain 3, 4.
- A single course of corticosteroid therapy, such as betamethasone or dexamethasone, may be recommended for fetal lung maturation 3.
- Heparin and dexamethasone have been compared as treatment options, with dexamethasone associated with faster regression and lower incidence of complications 6.