What is the treatment for HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome?

From the Guidelines

The primary treatment for HELLP syndrome is prompt delivery of the baby, regardless of gestational age, as this is the only definitive cure for the condition, and women with HELLP syndrome should be delivered promptly once maternal coagulopathy and severe hypertension have been corrected 1.

Key Considerations

• Blood pressure management is essential, with medications like labetalol, nifedipine, or methyldopa used to maintain blood pressure below 160/110 mmHg, and for women with severe hypertension, treatment should be initiated urgently in a monitored setting with antihypertensive therapy using oral labetalol, nifedipine or methyldopa, and intravenous therapy with labetalol or hydralazine may be required 1.
• Magnesium sulfate should be given to women with HELLP syndrome with co-existing severe hypertension to prevent eclamptic seizures, and also as a neuroprotective agent for preterm preeclampsia if delivery is required before 32 weeks’ gestation 1.
• Corticosteroids, such as high-dose dexamethasone or betamethasone, should be given to improve fetal lung maturity if a pregnancy complicated by HELLP syndrome is to be delivered before 35 weeks’ gestation 1.
• Platelet transfusions may be necessary if counts fall below 20,000/μL or before cesarean delivery if below 50,000/μL.

Supportive Care

• Close monitoring of liver function, kidney function, and coagulation parameters is essential.
• After delivery, most patients show improvement within 48-72 hours, though complete resolution may take longer.
• HELLP syndrome is a life-threatening complication of pregnancy characterized by microangiopathic hemolytic anemia, liver dysfunction, and thrombocytopenia, requiring immediate intervention to prevent maternal and fetal mortality.

Additional Recommendations

• Women with a history of prior HELLP syndrome should undergo first-trimester screening to assess the risk of early-onset preeclampsia 1.
• Aspirin prophylaxis should be given to women identified at high-risk of preterm preeclampsia, commencing before 16+0 weeks’ gestation at a dose of 150 mg to be taken every night until either 36 weeks’ gestation, when delivery occurs, or when preeclampsia/HELLP syndrome is diagnosed 1.

From the Research

Treatment for HELLP Syndrome

The treatment for HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome is a complex process that involves several steps.

• The primary goal of treatment is to stabilize the mother and the fetus, and to prevent further complications.
• According to 2, conservative treatment may be considered in selected cases less than 34 weeks' gestation, but delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the fetal and/or maternal conditions deteriorate.
• Vaginal delivery is preferable, but if the cervix is unfavorable, it is reasonable to induce cervical ripening and then labor.
• Corticosteroid therapy, such as betamethasone or dexamethasone, may be used to promote fetal lung maturation, especially in gestational ages between 24 and 34 weeks 2, 3, 4.
• However, the use of corticosteroids in HELLP syndrome is still a topic of debate, and some studies suggest that they may not have a significant impact on substantive clinical outcomes 3, 4.

Corticosteroid Therapy

Corticosteroid therapy is commonly used in the treatment of HELLP syndrome, but its effectiveness is still uncertain.

• Studies have shown that corticosteroids can improve platelet count and reduce the risk of maternal and fetal complications 3, 4, 5.
• Dexamethasone has been shown to be superior to betamethasone in improving platelet count and reducing the risk of maternal and fetal complications 3, 4.
• However, the exact mechanism of action of corticosteroids in HELLP syndrome is still unclear, and further research is needed to fully understand their role in the treatment of this condition 6.

Management of HELLP Syndrome

The management of HELLP syndrome requires close surveillance of the mother and the fetus, and prompt intervention if complications arise.

• Blood pressure should be kept below 155/105 mmHg, and close surveillance of the mother should be continued for at least 48 hours after delivery 2.
• The use of corticosteroids may be justified in clinical situations in which increased rate of recovery in platelet count is considered clinically worthwhile 3.
• Further research is needed to fully understand the pathophysiology of HELLP syndrome and to develop effective treatments for this condition.