Definition: haemolysis, elevated liver enzymes, low platelets. HELLP syndrome is considered a variant of severe pre-eclampsia (1).
Measurements: haemolysis is diagnosed by observation of fragmented red blood cells and shistocytes on a blood film, elevated lactate dehydrogenase levels (LDH>600 IU/l), elevated total bilirubin often in association with a decreasing haematocrit or the presence of a bleeding diathesis, and a platelet count of <100 G/l (1).
Treatment: a systematic review concluded there was insufficient evidence either to refute or to support adjuvant corticosteroid use (dexamethasone 10-12 mg or betamethasone 12 mg). Consistent with observational studies, corticosteroids were shown to increase the platelet count if given in the antenatal period, an the authors concluded that corticosteroids may be justified in clinical situation where an increased rate of recovery in platelet count is clinically useful. This did not translate to improvement in outcomes and the clinical relevance of this is unclear. On the basis of the available evidence, it is also not clear whether administration of corticosteroids to increase platelet count to generate a number at which one could safely undertake neuraxial anaesthesia is beneficial or harmful. There is no data to support the use of dexamethasone in the postpartum period (1).