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Introduction: HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome is a hypertensive disorder in pregnancy with severe pre-eclampsia, resulting in increased maternal and neonatal morbidity and mortality. The management of HELLP syndrome is controversial because the pathophysiology of the disease is not well understood. The current standard of care is supportive therapy and immediate delivery of the fetus.  However, the use of corticotherapy may have potential benefit on improving maternal recovery, but various studies reported inadequate and inconsistent findings. 

Case presentation: A 25-year-old pregnant patient presented to the emergency room with vaginal bleeding and hypertension. She was diagnosed with severe pre-eclampsia and underwent delivery via a cesarean section and was then transferred to the intensive care unit (ICU) due to exacerbation of HELLP syndrome. Prompt initiation of supportive care was provided and dexamethasone 10 mg IV Q 12 hours was administered. The patient recovered and was discharged from the hospital four days after corticotherapy was initiated, on day eight.

Conclusion: Various studies evaluated the use of corticosteroids, specifically dexamethasone, in the improvement of HELLP syndrome and maternal outcomes. Evidence on the management of the syndrome remains controversial due to limits in the strength of the conclusions of various clinical trials. As a result, the evidence is insufficient to justify the use of corticotherapy in the management of HELLP syndrome to improve maternal outcomes.