European Journal of Obstetrics & Gynecology and Reproductive Biology 80 (1998) 139–141 Is conservative treatment of HELLP syndrome safe? a a, b b a * ´ V. Tsatsaris , B. Carbonne , M. Dupre La Tour , D. Cabrol , J. Milliez a ˆ Department of Obstetrics and Gynecology, Hopital Saint- Antoine, 184 Rue du Faubourg Saint- Antoine, 75012 Paris, France b ´ Maternite Port-Royal – Baudelocque, Paris, France Received 23 December 1997; accepted 12 May 1998 Abstract HELLP syndrome is associated with a high rate of maternal and perinatal morbidity and mortality, and often leads to immediate fetal extraction. However, this condition may occur very early in pregnancy and conservative approaches have been recently proposed. The limits of this approach are discussed with two cases of conservative management of HELLP syndrome complicated by abruptio placentae.  1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: HELLP syndrome; Abruptio placentae; Corticosteroids 1. Introduction 1.1. Case 1 Any delay in the diagnosis of HELLP syndrome [1] may A 24-year-old para 4, gravida 4, with no previous lead to severe maternal and perinatal complications among medical history was admitted to the Port-Royal-Baudeloc- which intravascular disseminated coagulation, abruptio que Maternity at 27.5 weeks’ gestation with epigastric pain placentae, acute renal failure, pulmonary edema, hepatic and acoustic symptoms. Blood pressure was 140/90 hematoma and eclampsia [2–4]. Early recognition of this mmHg and the urine test was positive for proteins. The condition usually leads to prompt delivery and avoids most fetus was adequate for gestational age clinically and at of the previously listed complications and maternal / ultrasonography. The non-stress test was normally fluctuat- perinatal mortality. On the other hand, immediate fetal ing and reactive. 6 extraction is responsible for neonatal morbidity and mor- Blood tests gave the following results: platelets 55?10 / tality due to severe prematurity. l, hemoglobin 10.5 g / dl, LDH 412 UI / l, haptoglobin For these reasons, some authors have proposed a ,0.45 g/l ( N.0.6), schistiocytes 0, ASAT 41 UI/l, conservative approach of HELLP syndrome, especially ALAT,40 UI / l, uricemia 354 mmol / l, proteinuria 460 when occurring before 30–32 weeks’ gestation [6–9]. The mg / 24 h. The initial treatment aimed to promote fetal lung treatment is mainly based on high-dose corticosteroid maturity with i.v. betamethasone 12 mg per day for two administration (i.e., dexamethasone 10 mg every 12 h) and days. The patient was on bed rest with no other treatment. possibly volemic expansion and vasodilatation. Forty-eight hours after initiation of corticosteroids, the We report two cases of HELLP syndrome managed blood pressure had returned to normal, proteinuria was ,5 6 conservatively and the subsequent complications of such a mg / 24 h, the platelet count was 110?10 /l. Other bio- treatment. logical features were unchanged. Because of the early gestational age and improvement of clinical and biological features, corticosteroid treatment * was pursued for 41 days. At 33.5 weeks’ gestation, Corresponding author. Tel.: 133 1 49282745; fax: 133 1 49282756; e-mail: carbonne@easynet.fr emergency cesarean section was performed because of flat 0301-2115 / 98 / $19.00  1998 Elsevier Science Ireland Ltd. All rights reserved. PII: S0301-2115(98)00108-0