Methods	Prospective, double blind, placebo controlled randomized clinical trial
Participants	132 eligible women with gestational age > 20 weeks (60 pregnant, 72 postpartum, mean age 25.3 years (range 14-44), mean parity 2.4, gestation 20-41 weeks) Inclusion criteria: women diagnosed with class 1 or 2 HELLP syndrome pregnant or just after delivery (within 3 days of delivery) Exclusion criteria: oral temperature > 37.5 degrees celsius, diabetic ketoacidosis, for women postpartum - more than 24 hours elapsed since diagnosis (28% of the sample (women with GA 26-36 weeks) had betamethasone in the 2 weeks before delivery for fetal lung maturation.)
Interventions	Intervention: dexamethasone (pregnant women 10 mg doses IV every 12 hours until delivery and 3 doses after delivery; postpartum women 3 10 mg doses) Comparison group: placebo (sterile water IV) same regimen. Treatment was discontinued if temp rose above 37.5c. All women received 1-1.5 g/hr of magnesium sulfate IV and anti-hypertensive and/or hydration therapy as required
Outcomes	Duration of hospital stay (randomization to discharge). Platelet count > 100,000 cells/mm3, LDH, AST. Complications: acute renal failure, oliguria, pulmonary edema, eclampsia, infections, maternal death, need for platelet transfusion, need for plasma transfusion
Notes
Risk of bias
Item	Authors’ judgement	Description
Adequate sequence generation?	Yes	Stratified permuted blocks of 4.
Allocation concealment?	Yes	Consecutively numbered opaque envelopes, with active and placebo preparations packed in identical vials in sealed, coded boxes
Blinding? All outcomes	Yes	Adequate for women, staff and outcome assessors; placebo controlled trial with codes not broken until after analysis
Incomplete outcome data addressed? All outcomes	Yes	Adequate; 132 women were randomized, there were 6 protocol violations, (4 in intervention group and 2 in placebo) but authors report that they carried out an ITT analysis
Free of other bias?	Yes	No baseline imbalance apparent.
Overall risk of bias?	No	Low risk of bias.