Modified Mississippi protocol for HELLP/partial HELLP syndrome occurring in the periviable period: A report of three cases

Abstract

HELLP syndrome is a life-threatening complication of pregnancy that requires immediate delivery. Temporizing management for short durations (24–48 hours) may be an acceptable option. However, there is insufficient information on long-term expectant management (≥48 hours) for HELLP syndrome occurring during the periviable period (22–24 weeks of gestation). The Mississippi protocol, which includes high doses of dexamethasone in combination with antihypertensives and magnesium sulphate, is usually used for planned delivery within 48 hours after diagnosis of HELLP syndrome to prevent severe maternal morbidity. Here we present three cases of HELLP/partial HELLP syndrome occurring during the periviable period, which were treated with a modified Mississippi protocol. The modified Mississippi protocol involved administration of three-day, high-dose dexamethasone followed by long-term, low-dose prednisolone (10 mg/day). The modified Mississippi protocol contributed to prolongation of pregnancy (8, 10, and 16 days), and may be a promising therapeutic option especially for periviable HELLP/partial HELLP syndrome.