In a patient with HELLP syndrome at 28 weeks gestation, which intervention has the strongest evidence for prolonging pregnancy and improving perinatal outcome?

• A High-dose dexamethasone to reverse HELLP and allow conservative management
• B Antenatal corticosteroids for fetal lung maturity followed by delivery after 48 hours ✓
• C Plasma exchange to reverse microangiopathic process
• D Platelet transfusion to maintain count > 50,000/µL to allow ongoing pregnancy

Explanation

In HELLP syndrome remote from term (< 34 weeks), administration of antenatal corticosteroids for fetal lung maturation followed by delivery after a 48-hour window is the best supported approach. While dexamethasone was historically used to reverse HELLP, systematic reviews (including the Martin regimen) have shown it does not improve maternal outcomes and does not justify prolonging pregnancy beyond the steroid window. Delivery remains the definitive treatment.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.