Prolongation of premature gestation in women with hemolysis, elevated liver enzymes and low platelets. A report of five cases.

Severe pregnancy-induced hypertension complicated by hemolysis, elevated liver enzymes and low platelets (HELLP) is considered an indication for immediate delivery, often resulting in premature or even previable infants. In five cases, temporary reversal of the HELLP syndrome was achieved using low-dose aspirin and corticosteroids. Pregnancy was prolonged an average of 4 weeks; three pregnancies were prolonged, beginning at less than or equal to 25 weeks, for an average of 5.5 weeks. Two of seven infants died, one from pulmonary hypoplasia due to oligohydramnios and the other from complications of prematurity. No long-term maternal morbidity was encountered, though one patient had peripartum disseminated intravascular coagulation and a seizure. A review of the literature supports the usefulness of low-dose aspirin in this setting; the impact of corticosteroids as part of the reversal strategy has not been discussed previously.