A multiparous woman at 36+2 weeks develops HELLP syndrome (platelets 62,000/µL, AST 220 IU/L, LDH 890 IU/L). Blood pressure is 148/96 mmHg with no severe symptoms. What is the most appropriate management?

• A Expectant management with corticosteroids until 37 weeks
• B Immediate delivery after steroid administration ✓
• C Plasmapheresis and delay delivery 48 hours
• D IV dexamethasone alone without delivery

Explanation

HELLP syndrome at ≥34 weeks is an indication for delivery regardless of BP severity, as expectant management carries risk of maternal complications including hepatic rupture, DIC, and placental abruption. Betamethasone or dexamethasone may be given for fetal lung maturity but should not delay delivery. Plasmapheresis has no established role in HELLP. Delivery — ideally within 24–48 hours of steroid administration at 34–36 weeks — is the definitive treatment.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.