High-order multiple pregnancies complicated by HELLP syndrome. A report of four cases with corticosteroid therapy to prolong gestation.

BACKGROUND: Previously, HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) was perceived as an indication for immediate delivery. This often results in delivery of infants remote from term and with significant morbidity and mortality for both mother and neonates. While stabilization of maternal status has been reported to occur in singleton pregnancies with the use of antepartum administration of high-dose corticosteroids, it has not been reported to occur in high-order multiple pregnancies. We extended the use of corticosteroids to high-order multiple pregnancies complicated by HELLP syndrome to stabilize the disease process and lengthen gestation.

CASES: Four cases of high-order multiple pregnancies complicated by HELLP syndrome were treated with high-dose, long-term corticosteroids to prolong gestation. The administration of dexamethasone resulted in stabilization of laboratory values and prolongation of gestation by 29, 6, 20 and 41 days, respectively.

CONCLUSION: Antepartum administration of high-dose corticosteroids in high-order multiple pregnancies complicated by HELLP syndrome stabilized laboratory values and prolonged gestation in four patients remote from term.