126 Obstetrics and Gynecology Board Review •••
❍ How should steroids be administered for HELLP syndrome?
There are two possible regimens: 12 mg of betamethasone IM every 24 hours for two doses or 6 mg of
dexamethasone IM every 12 hours for a total of 4 doses.
Other regimens of steroids including high dose treatment after 34 weeks or postpartum are experimental. There is
insufficient evidence to determine whether adjunctive steroid use in HELLP syndrome decreases maternal and
perinatal mortality.
❍ Which methods for pain control are contraindicated in HELLP syndrome?
Pudendal block in contraindicated due to the risk of bleeding and hematoma formation. Epidural anesthesia is
contraindicated, especially when thrombocytopenia is <75,000/mm^3.
❍ What are the indications for platelet transfusion?
A level <20,000/mm^3 or the presence of significant bleeding. Some recommend transfusion of six units of platelets
prior to surgery if the level is <40,000/mm^3.
❍ What is the recommended postpartum treatment?
Supportive therapy with continuation of magnesium sulfate prophylaxis for 24 to 48 hours and the use of
antihypertensives to keep blood pressure below 155/105 mmHg.
❍ What is the rate of preeclampsia in subsequent pregnancies?
Approximately 20%.
❍ What is the rate of recurrent HELLP syndrome?
2% to 19%.
❍ How is chronic hypertension defined?
Hypertension (systolic pressure of 140 mmHg or above, diastolic pressure of 90 mmHg or above) present before
the 20th week of gestation (not attributable to gestational trophoblastic disease) or hypertension present before
pregnancy with the use of antihypertensive medications, or hypertension that persists longer than 12 weeks
postdelivery.
❍ What are the criteria for diagnosing mild and severe chronic hypertension?
- Mild: Systolic blood pressure 140 to 159 mmHg or diastolic blood pressure 90 to 109 mmHg.
- Severe: Systolic blood pressure 160 mmHg or greater or diastolic blood pressure 110 mmHg or greater.
❍ How is chronic hypertension classified according to the Joint National Committee (2003)?
Prehypertension (systolic 120–139 or diastolic 80–90), stage 1 hypertension (140–159 or 90–99) and stage 2
hypertension (160 or above or 100 or above).
❍ What are some benefits associated with antihypertensive treatment in nonpregnant women?
Decreased mortality and stroke and major cardiac events.