Administration of corticosteroid therapy for HELLP syndrome in pregnant women: evidences from seven randomized controlled trials

Figures & data

Figure 1. Study selection.

Figure 2. Overall outcomes of maternal and fetus under intervention and reasons of fetus mortality.

Table 1. Basic characteristics of including studies.

Author	Year	Nation	Type of trial	Sample (C/P)	Delivery (Vaginal/Cesarean)	Maternal age (year, mean±SD)	Gestational age (week, mean±SD)	Dosage and means of medication (C/P)	Duration of hospitalization (mean±SD)
Fonseca	2019	American	DB-RCT	42; 45	18\24; 16\29	24.24 ± 7.20; 27.22 ± 7.94	34.11 ± 4.79; 33.60 ± 4.97	For pregnant of intervention: 10-mg doses of dexamethasone, intravenously, every 12 h until delivery and 3 additional doses after delivery; For postpartum of intervention: 10-mg doses of dexamethasone, intravenously, every 8 h after delivery; Control: Sterile water as placebo	4.59 ± 4.91d; 3.93 ± 2.78d
Katz	2008	Brazil	DB-RCT	56; 49	42/14; 42/7	25.5 ± 5.7; 28.1 ± 7.9	34.2 ± 4.2; 33.8 ± 3.5	Intervention: 1 ampule of dexamethasone, intravenous; Control: Placebo solution	10.2 ± 5.3d; 10.5 ± 3.5d
Magann	1994	American	RCT	12; 13	NR	23.7 ± 7.5; 23.6 ± 4.7	30.7 ± 4.9; 32.8 ± 4.7	Intervention: Double-dose of 10 mg dexamethasone, intracenously, every 12 h until delivery; Control: Not receive any corticosteroids	NR
Fonseca	2005	American	DB-RCT	66; 66	NR	24.5 ± 7.00; 26.2 ± 7.20	33.8 ± 4.50; 33.5 ± 4.20	For pregnant of intervention: 10 mg of dexamethasone, intravenously, every 12 h until delivery and 3 additional doses after delivery; For puerperal of intervention: 10 mg of dexamethasone, intravenously, every 8 h after delivery; Control: Sterile water as placebo.	6.5d; 8.2d
Ozer	2009	Turkey	RCT	30; 30	7/23; 2/26	28.5 ± 7.3; 27.9 ± 7.1	32.4 ± 4.5; 33.1 ± 3.7	Intervention: 12 mg betamethasone, intramuscular, every 24 h; Control: Sterile water as placebo	99.4 ± 47.3 h; 97.4 ± 42.0 h
Van	2006	Netherlands	DB-RCT	15; 16	0/15; 2/14	31.6 ± 2.5; 30.9 ± 3.3	27.4 ± 1.4; 27.6 ± 1.2	Intervention: 50 mg of prednisolone dissolved in 100 ml of sodium chloride, intravenously, every 12 h; Control: 100 ml sodium chloride as placebo, intravenously.	8.5 ± 2.4d; 9.1 ± 7.6d
Barrilleaux	2005	American	RCT	77; 80	NR	24.5 ± 6.8; 23.9 ± 6.4	33.8 ± 4.0; 32.8 ± 4.3	Intervention: 2 doses of 10 mg dexamethasone folled by 2 doses of 5 mg dexamethasone, intravenously, every 12 h for 4 total doses at 0, 12, 24, 36 h postpartum; Control: Equal volume of placebo, intravenously	4.0d; 4.0d

C: corticosteroids; P: placebo; DB-RCT: double-blind randomized clinical trial; RCT: randomized clinical trial; d: days; h: hours; NR: Not reported; SD: standard deviation.

Table 2. Risk of bias for randomized controlled trials.

Study	Randomisation	Effect of Assignment to Intervention	Missing Outcome Data	Measurement of the Outcome	Selection of Reported Result	Overall Risk
Fonseca, 2019 (23)	Low risk	Low risk	Some risk	Low risk	Low risk	Some risk
Katz, 2008 (24)	Low risk	Low risk	High risk	Low risk	Low risk	High risk
Magann, 1994 (25)	Some risk	Some risk	High risk	Some risk	Some risk	High risk
Fonseca, 2005 (22)	Low risk	Low risk	High risk	Low risk	Low risk	High risk
Ozer, 2009 (14)	Some risk	Some risk	High risk	Low risk	Low risk	High risk
Van, 2006 (26)	Low risk	Low risk	Some risk	Low risk	Some risk	Some risk
Barrilleaux, 2005 (21)	Some risk	Some risk	High risk	Low risk	Some risk	High risk

Figure 3. Forest plot of maternal mortality.

Figure 4. Forest plot of eclampsia.

Figure 5. Forest plot of acute renal failure.

Figure 6. Forest plot of pulmonary edema.

Figure 7. Forest plot of oliguria.

Fonseca JE, Otero JC, Messa C. Dexamethasone for the treatment of class I HELLP syndrome: a double-blind, placebo-controlled, multicenter, randomized clinical trial. Pregnancy Hypertens. 2019;17:158–164. doi: 10.1016/j.preghy.2019.06.003

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Ozer A, Kanat-Pektas M, Ozer S, et al. The effects of betamethasone treatment on clinical and laboratory features of pregnant women with HELLP syndrome. Arch Gynecol Obstetrics. 2009;280(1):65–70. doi: 10.1007/s00404-008-0865-3

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van Runnard Heimel PJ, Huisjes AJ, Franx A, et al. A randomised placebo-controlled trial of prolonged prednisolone administration to patients with HELLP syndrome remote from term. Eur J Obstet Gynecol Reprod Biol. 2006;128(1–2):187–193. doi: 10.1016/j.ejogrb.2005.11.041

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Barrilleaux PS, Martin JN Jr., Klauser CK, et al. Postpartum intravenous dexamethasone for severely preeclamptic patients without hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome: a randomized trial. Obstet & Gynecol. 2005;105(4):843–848. doi: 10.1097/01.AOG.0000154887.57440.d1

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Data availability statement

All data generated or analyzed during this study are included in this published article.