A patient with HELLP syndrome Class I (Mississipi classification) at 33 weeks is given dexamethasone. Which of the following correctly describes the rationale and evidence for corticosteroid use in HELLP syndrome?
- A Betamethasone is preferred over dexamethasone for HELLP because of superior platelet effect
- B Dexamethasone improves platelet count and laboratory parameters but has not been shown to improve maternal outcomes in large RCTs ✓
- C Corticosteroids reverse the hepatocellular damage by inhibiting TNF-mediated apoptosis and are recommended in all cases
- D Dexamethasone delays delivery by >48 hours in 90% of HELLP cases allowing safe antepartum transfer
Correct answer: B. Dexamethasone improves platelet count and laboratory parameters but has not been shown to improve maternal outcomes in large RCTs
Explanation
Multiple studies and meta-analyses show that dexamethasone (12 mg IV q12h) or betamethasone can transiently improve platelet counts and biochemical parameters in HELLP syndrome. However, the large COHELLP RCT (2012) demonstrated no significant improvement in maternal outcomes (death, organ failure, serious morbidity). Current evidence does not support routine corticosteroid use for maternal benefit in HELLP; antenatal steroids are given only for fetal lung maturity at <34 weeks.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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