Key messages

• High maternal and fetal morbidity and mortality characterize the syndrome.

• Termination of pregnancy and expeditious delivery are standard treatments.

• Conservative treatment to allow fetal maturity has been evaluated and appears promising in well-monitored patients fulfilling certain criteria. This hemodynamically guided therapy can control and sometimes even reverse the syndrome.

• Antepartum and postpartum steroid therapy is a possible adjunctive treatment.

• Plasma exchange with fresh frozen plasma has been proposed for persisting or worsening HELLP syndrome. However, delivery remains the most effective therapy and is an absolute indication in the presence of eclampsia, abruptio placentae, disseminated intravascular coagulation, fetal distress, or liver hematoma. Bleeding disorders, subcapsular liver hematoma, and hepatic rupture remain the most feared complications and must be promptly excluded.

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