A patient with HELLP syndrome (Sibai's Class I) has platelets 48,000/µL at 28 weeks gestation. After 48 hours of betamethasone and stabilization, which decision best reflects current evidence?
- A Deliver immediately regardless of fetal maturity
- B Deliver after 48 hours of corticosteroids at ≥ 34 weeks; at 28 weeks, continue expectant management only if stable ✓
- C Deliver at 34 weeks after repeat steroid course
- D Conservative management to 37 weeks with weekly LFTs
Correct answer: B. Deliver after 48 hours of corticosteroids at ≥ 34 weeks; at 28 weeks, continue expectant management only if stable
Explanation
Sibai's Class I HELLP (platelets < 50,000/µL) represents the most severe tier. At ≥ 34 weeks, delivery is indicated after initial steroid course for maternal reasons. At < 34 weeks, a brief period of expectant management (48–72 hours) after corticosteroid administration may be considered in carefully selected stable patients to gain fetal lung maturity benefit, but deterioration mandates immediate delivery. Delaying to 37 weeks is never appropriate in HELLP syndrome, as it carries significant risk of maternal morbidity including DIC, placental abruption, and hepatic rupture.
Reference: Williams Obstetrics, 26th ed.
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