Monitoring
In patients not receiving corticosteroids, platelet count usually decreases at an average rate of approximately 40% per day, while lactate dehydrogenase (LDH) values increase. This trend may continue for 24 to 48 hours following delivery, in parallel with a decrease in haematocrit.[2]
Recovery occurs much more rapidly in patients treated with intravenous dexamethasone. Monitoring of laboratory parameters is recommended every 12 to 24 hours postpartum. Improvement in platelet count and liver enzymes should be seen not later than postpartum day 4 if there are no further complications.[2][116]
Failure of the patient to show signs of response and recovery to therapy should be apparent by the second to third day of management using the recommended therapies. If maternal status is worsening, consideration for another diagnosis should be given and plasma exchange considered (haematology consult).[2]
Cases of thrombotic thrombocytopenic purpura or haemolytic uraemic syndrome misdiagnosed as HELLP syndrome may be life-threatening unless plasma exchange with fresh frozen plasma is instituted without undue delay. The elevation in aspartate aminotransferase (AST) levels is, in general, modest in HELLP syndrome. AST levels >2000 IU/L and LDH levels >3000 IU/L are unusual in HELLP syndrome and indicate a high risk of death.
In the normalisation phase, the majority of patients not treated with corticosteroids attain a platelet count ≥100,000/mm³ by postpartum day 6.[2][30] A rebound phenomenon may follow, with platelet counts reaching values sometimes >800,000/mm³.
In 20% of patients, total bilirubin may remain elevated for up to 31 months after delivery, despite normalisation of liver enzymes.[117]
Patients generally pass from obstetrical care after 6 weeks, and any follow-up monitoring required after that time would be undertaken by the patient's non-obstetrical physicians.
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