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. Author manuscript; available in PMC: 2014 Sep 22.
Published in final edited form as: Cochrane Database Syst Rev. 2010 Sep 8;(9):CD008148. doi: 10.1002/14651858.CD008148.pub2
Methods RCT.
Participants 30 postpartum women with a diagnosis of HELLP syndrome while pregnant from symptoms and laboratory findings. Hemolysis, elevated liver enzymes (AST > 48 IU/L, ALT > 24 IU/L) low platelets (< 100,000 cells/mm3)
All women were delivered within 72 hrs of admission (IOL initiated with CS for fetal distress). Women randomized following delivery
Interventions Intervention group: immediately after delivery 10 mg dexamethasone IV, then 10 mg at 12 hrs, and 5 mg at 24 and 36 hrs (total dose over 36 hrs = 30 mg)
Control group: no steroids.
Women in both groups had anti-convulsive therapy (IV magnesium sulfate - bolus 4 g then 1 g/hr over 48 hrs). Anti-hypertensive therapy as required (> 160/110 mmHg)
Careful monitoring in both groups (arterial BP and urine output monitored 2 hrly) and lab tests 6-12 hrly
All women remained in ICU until symptoms and lab tests showed signs of remission
Outcomes Outcomes: Mean arterial BP, urine output, laboratory findings (AST, ALT, platelet count, hematocrit). Mean length of hospital stay
Notes
Risk of bias
Item Authors’ judgement Description
Adequate sequence generation? Unclear Not described.
Allocation concealment? Unclear Women were “randomly assigned”.
Blinding?
All outcomes
Unclear No blinding of women or clinical staff. It was not clear if outcome assessors were blind
Incomplete outcome data addressed?
All outcomes
Yes All women seem to be accounted for in the analyses. 2 women died before delivery (before randomization)
Free of other bias? Yes Groups appear similar at baseline. Very little information on study methods
Overall risk of bias? Unclear Possible performance and selection bias, it was not clear how randomization was achieved or if blinding occurred

ALT: alanine transaminase

ARDS: acute respiratory distress syndrome

AST: aspartate transaminase

BP: blood pressure

CS: caesarean section

DIC: disseminated intravascular coagulation

GA: gestational age

GI: gastrointestinal

HELLP: hemolysis, elevated liver enzymes and low platelets

hr: hour

hrly: hourly

ICU: intensive care unit

IOL: induction of labor

ITT: intention to treat

IM: intramuscular

IV: intravenous

LDH: lactate dehydrogenase

MAP: mean arterial pressure

RCT: randomized controlled trial

RDS: respiratory distress syndrome