There was no clear evidence of any effect of corticosteroids on substantive clinical outcomes. Those receiving steroids showed significantly greater improvement in platelet counts which was greater for those receiving dexamethasone than those receiving betamethasone. There is to date insufficient evidence of benefits in terms of substantive clinical outcomes to support the routine use of steroids for the management of HELLP. The use of corticosteroids may be justified in clinical situations in which increased rate of recovery in platelet count is considered clinically worthwhile.
Dexamethasone treatment does not improve the outcome of women with HELLP syndrome: a double-blind, placebo-controlled, randomized clinical trial.
The purpose of this study was to determine the efficacy of dexamethasone for treatment of HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome.
                A prospective, double-blind clinical trial was conducted among 132 women with HELLP syndrome who were assigned randomly to treatment or placebo groups. Pregnant women in the experimental group received 10-mg doses of dexamethasone intravenously every 12 hours until delivery and 3 additional doses after delivery. Puerperal women received 3 10-mg doses of dexamethasone after delivery. The same schedule was used in the placebo group. The main outcome variable was the duration of hospitalization. In addition, we evaluated treatment effects on the time to recovery of laboratory and clinical parameters and on frequency of complications.
                The mean duration of hospitalization of patients who received dexamethasone therapy was shorter than in the placebo group (6.5 vs 8.2 days), but this difference was not statistically significant (P = .37). No significant differences were found in the time to recovery of platelet counts (hazard ratio, 1.2; 95% CI, 0.8-1.8), lactate dehydrogenase (hazard ratio, 0.9; 95% CI, 0.5-1.5), aspartate aminotransferase (hazard ratio, 0.6; 95% CI, 0.4-1.1) and to the development of complications. The results were found in both pregnant and puerperal women.
                The results of this investigation do not support the use of dexamethasone for treatment of HELLP syndrome.