Multidisciplinary management strategies for HELLP syndrome in obstetric intensive care

Abstract

Introduction: Hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome) is one of the most severe forms of hypertensive disease in pregnancy, and its management in obstetric intensive care continues to be supported by heterogeneous evidence.

Objective: To examine the available evidence on multidisciplinary management strategies for HELLP syndrome in high-complexity settings, with emphasis on maternal and perinatal outcomes and progression to organ failure.

Methods: A systematic review without meta-analysis was conducted. Primary studies published between January 2020 and October 2025 were searched in PubMed/MEDLINE, Embase, Scopus, Web of Science, and LILACS, in English or Spanish. Clinical trials and observational studies in pregnant or postpartum patients with HELLP syndrome were included; two reviewers performed study selection, data extraction, and narrative synthesis.

Results: Gestational age at diagnosis, acute kidney injury, and multiorgan involvement were associated with worse outcomes. Expectant management appeared feasible only in selected preterm patients, whereas rescue therapies showed partial improvement in refractory subgroups, although heterogeneity across studies limited comparability.

Conclusions: In critical settings, the prognosis of HELLP syndrome appeared to depend on timely recognition, initial severity stratification, and intensive monitoring. Gestational age at diagnosis, acute kidney injury, and multiorgan involvement emerged as relevant modifiers of clinical outcomes. Comparative studies using uniform diagnostic criteria and patient-centered outcomes are still needed.