What are the indications for immediate delivery in a patient with HELLP syndrome?

Indications for immediate delivery in a patient with HELLP syndrome include:

• Severe hypertension that is unresponsive to treatment.
• Progressive deterioration in maternal condition, including worsening laboratory parameters such as falling platelet count, rising liver transaminases, or rising creatinine.
• Presence of maternal organ dysfunction such as liver involvement with epigastric pain, neurological complications (e.g., eclampsia, altered mental status), or haematological complications (e.g., thrombocytopenia, disseminated intravascular coagulation, haemolysis).
• Signs of fetal compromise such as fetal growth restriction, abnormal umbilical artery Doppler waveform, or stillbirth.
• Severe pre-eclampsia features including ongoing or recurring severe headaches, visual disturbances, nausea or vomiting, and oliguria.

In summary, immediate delivery is indicated when there is evidence of severe maternal or fetal compromise in HELLP syndrome to prevent further morbidity or mortality ¹.