Milestones in the quest for best management of patients with HELLP syndrome (microangiopathic hemolytic anemia, hepatic dysfunction, thrombocytopenia)

In the 3 decades since the original description and naming of the dangerous pregnancy complication called HELLP syndrome, many milestones have been passed in pursuit of a better understanding of the disorder and its best management. It is worthwhile to review the milestones through which we have passed internationally in obstetrics as the peril that this disorder poses to pregnancy has been exposed. Factors of importance for emphasis will be definitions, reasons why the triple classification system impacts practice, the important role glucocorticoids have in reversing the pathogenesis of the disorder if used early, the excellent results reported for mothers when all components of the Mississippi Protocol are utilized for patient care, and the place of plasma exchange in special situations. Our challenge for the future is to delay or prevent HELLP's development prior to potential viability so that stillbirths and very preterm losses can be reduced or eliminated.