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Inta A, Tongsong T, Srisupundit K. Pregnancy Outcomes of Conservative Management in Preeclampsia with Severe Features. J Clin Med 2023; 12:6360. [PMID: 37835004 PMCID: PMC10573983 DOI: 10.3390/jcm12196360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/19/2023] [Accepted: 09/30/2023] [Indexed: 10/15/2023] Open
Abstract
Objective: To study the pregnancy outcomes of conservative treatment for preeclampsia with severe features. Methods: A retrospective study was conducted on pregnancies with preeclampsia with severe features at gestational age 23-34 weeks and that received conservative management at Chiang Mai University Hospital between January 2014 and August 2020. The women were divided into two groups: (1) pregnancy prolongation of at least 48 h and (2) pregnancy prolongation of less than 48 h. Results: Of the 100 recruited pregnancies, the median gestational age was 29 weeks (range 23-34). Of these, 65 cases (65%) had pregnancy prolongation of at least 48 h, and 35 cases (35%) had prolongation of less than 48 h. The median pregnancy prolongation was 2.9 days (range 4 h-27.7 days). Eighty-seven (88%) pregnant women experienced no complications. Multivariate analysis shows that high urine protein/creatinine ratio (UPCI) at admission was significantly associated with pregnancy prolongation of less than 48 h with an odds ratio for prolongation for at least 48 h of 0.86 (95% CI 0.75-0.99: p-value 0.04). Kaplan-Meier analysis shows that the mean time of prolongation was 3.6 days vs. 6.7 days, and median time of prolongation was 2.1 days vs. 4.4 days in the group of high and low UPCI (using cut-off 1.0), respectively. The number of prolonged days was significantly lower in the high UPCI group than in the low UPCI group (log-rank test, p = 0.01). The maternal and fetal outcomes between the two groups were not significantly different. The cesarean section rate was also comparable. The mean birth weight and gestational age at delivery were not significantly different, though they had a higher trend in the group of successful conservative management. Conclusion: The rate of pregnancy prolongation of at least 48 h with conservative management was 65%, with a median prolongation time of 2.9 days. A new insight gained from this study is that high UPCI at admission is an independent factor for prolongation of less than 48 h with conservative treatment. Nevertheless, the maternal and fetal outcomes between the two groups were not significantly different. Therefore, the benefit and risk of expectant management in actual practice of service settings in terms of maternal and fetal morbidity is still unclear.
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Affiliation(s)
| | | | - Kasemsri Srisupundit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Lyu X, Zhang W, Zhang J, Wei Y, Guo X, Cui S, Yan J, Zhang X, Qiao C, Zhou R, Gu W, Chen X, Zi Y, Li X, Song Y, Lin J. Morbidity and maternal and infant outcomes of hypertensive disorder in pregnancy in China in 2018. J Clin Hypertens (Greenwich) 2021; 23:1194-1204. [PMID: 33788388 PMCID: PMC8678747 DOI: 10.1111/jch.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/24/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022]
Abstract
Hypertensive disorder in pregnancy is a disease that occurs during pregnancy. We aimed to analyze the morbidity and maternal and infant outcomes with respect to the hypertensive disorder in pregnancy in China in 2018. Clinical data of 38 590 cases from 161 hospitals were retrospectively collected. The differences in morbidity and maternal and infant mortality among the major regions and provinces were compared. The overall national average morbidity was 4.74%, and the ratios of gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia were 29.17%, 55.02%, 0.66%, 6.53%, and 8.62%, respectively. The overall maternal mortality was 0.61/100 000, and the case fatality was 0.13%. Morbidity associated with hypertensive disorder in pregnancy was 7.74% in North China, 6.62% in Northwest China, 6.40% in Central China, 5.83% in Northeast China, 4.28% in East China, 3.85% in South China, and 2.88% in Southwest China. The morbidity in each province was 1.62‐11.28%. The overall perinatal mortality was 3.59% (81.09% for stillbirths; 18.91% for neonatal deaths). Perinatal mortality decreased with increasing gestational weeks from 24 to 37 + 6 weeks. Perinatal mortality for delivery at 32 weeks of gestation in all regions of the country was <10%. Morbidity varied across regions in China, with the lowest in Southwest and the highest in North China. The low maternal mortality is related to the large‐scale development of standardized maternal health care in China. For severe hypertensive disorder patients, gestation should be prolonged to 32 weeks as often as possible for better neonatal survival rates.
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Affiliation(s)
- Xin Lyu
- School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Weiyuan Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jingxiao Zhang
- The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Yuqian Wei
- Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiaoli Guo
- Changzhi Maternity and Child Health Care Hospital, Changzhi, China
| | - Shihong Cui
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianying Yan
- Fujian Maternity and Child Health Care Hospital, Fuzhou, China
| | - Xiaoyan Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chong Qiao
- Shengjing Hospital Affiliated of China Medical University, Shenyang, China
| | - Rong Zhou
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Weirong Gu
- Fudan University Affiliated Hospital of Obstetrics and Gynecology, Shanghai, China
| | - Xianxia Chen
- Anhui Women and Child Health Care Hospital, Hefei, China
| | - Yang Zi
- Peking University Third Hospital, Beijing, China
| | - Xiaotian Li
- Fudan University Affiliated Hospital of Obstetrics and Gynecology, Shanghai, China
| | - Yanyan Song
- School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianhua Lin
- School of Medicine, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
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Wang Y, Bao J, Peng M. Effect of magnesium sulfate combined with labetalol on serum sFlt-1/PlGF ratio in patients with early-onset severe pre-eclampsia. Exp Ther Med 2020; 20:276. [PMID: 33200001 PMCID: PMC7664615 DOI: 10.3892/etm.2020.9406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/24/2020] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the therapeutic effect of magnesium sulfate combined with labetalol on the early-onset severe pre-eclampsia (ES-PE) and explore the role of soluble fms-like tyrosine kinase-1 (sFlT-1), placental growth factor (PlGF), and sFlt-1/PlGF ratio in the treatment. A total of 164 ES-PE patients admitted to the Maternity and Child Health Care Hospital of Hubei (Wuhan, China) were assigned to this observational study. Among them, 83 patients were enrolled in group A and treated with magnesium sulfate combined with labetalol hydrochloride, and 81 patients were enrolled in group B and treated with magnesium sulfate. The therapeutic effect, adverse reactions and pregnancy outcomes in the two groups were analyzed. Serum sFlt-1 and PlGF concentrations, before and after treatment, were measured by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of pre-treatment serum sFlt-1/PlGF ratio for the clinical outcome. The effective rate was significantly higher in group A than that in group B. Group A presented superior pregnancy outcomes over group B. The serum sFlt-1 concentration and sFlt-1/PlGF ratio after treatment were significantly lower than those before treatment in groups A and B, whereas PlGF concentration was significantly higher after treatment in both groups. After treatment, group A had markedly lower serum sFlt-1 concentration and sFlt-1/PlGF ratio than group B, and markedly higher PlGF concentration than group B. The area under curve (AUC) of serum sFlt-1/PlGF ratio before treatment for the prediction of the clinical efficacy was 0.737. In conclusion, magnesium sulfate combined with labetalol could be effectively used for the treatment of ES-PE. The results of ELISA revealed that the balance of sFlT-1 and PlGF was improved after treatment and the sFlT-1/PlGF ratio was decreased. The assessment of sFlt-1/PlGF ratio before treatment was shown to have a certain predictive value for the efficacy of ES-PE treatment.
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Affiliation(s)
- Ying Wang
- Department of Obstetrics, Maternity and Child Health Care Hospital of Hubei, Wuhan, Hubei 430000, P.R. China
| | - Jing Bao
- Department of Obstetrics, Maternity and Child Health Care Hospital of Hubei, Wuhan, Hubei 430000, P.R. China
| | - Min Peng
- Department of Obstetrics, Maternity and Child Health Care Hospital of Hubei, Wuhan, Hubei 430000, P.R. China
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Vigil-De Gracia P, Ludmir J. Conservative management of early-onset severe preeclampsia: comparison between randomized and observational studies a systematic review. J Matern Fetal Neonatal Med 2020; 35:3182-3189. [PMID: 32912001 DOI: 10.1080/14767058.2020.1814249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare maternal and perinatal outcomes between randomized trials and observational studies in which conservative management was performed for more than 48 h in patients with early-onset severe preeclampsia. METHODOLOGY We searched PubMed, LILACS, Cochrane and Google Scholar. The studies were divided in two groups: randomized and observational studies, from 1990 to 2018 that included patients with severe preeclampsia before 34 weeks of gestation with pregnancy prolongation ≥48 h but that did not include fetal growth restriction or HELLP syndrome at the beginning. The main variables recorded were maternal and perinatal complications. MAIN RESULTS Forty-four studies met the inclusion criteria, and 5 of these were randomized. The average pregnancy prolongation was 9 days, with no difference between groups. Maternal complications were significantly more common in observational studies, RR = 0.71, 95% CI (0.54-0.93), p = .009. Perinatal complications were also significantly more common in observational studies (RR = 0.89, 95% CI (0.80-0.98), p = .01) at the expense of stillbirth and neonatal deaths. The percentages of cesarean sections were significantly higher in randomized studies, RR = 1.54, 95% CI (1.46-1.64). There were 2 maternal deaths, both in observational studies. CONCLUSION Observational studies in which conservative management of early-onset preeclampsia is performed and do not include patients with fetal growth restriction or patients with HELLP syndrome and where at least 2 days of pregnancy prolongation is achieved are associated with significantly more maternal and perinatal complications.
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Affiliation(s)
- Paulino Vigil-De Gracia
- Distinguished researcher of the Panamanian National Research System, SENACYT Panamá, Panamá, PA, USA
| | - Jack Ludmir
- Thomas Jefferson University, Philadelphia, PA, USA
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Nwafor J, Ugoji DPC, Onwe B, Obi V, Obi C, Uchenna Onuchukwu V, Ibo C. Pregnancy outcomes among women with early-onset severe preeclampsia managed conservatively. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_28_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ozel A, Davutoglu EA, Firat A, Erenel H, Karslı MF, Korkmaz SÖ, Madazli R. Maternal serum irisin levels in early and late-onset pre-eclamptic and healthy pregnancies. J OBSTET GYNAECOL 2018; 38:642-646. [DOI: 10.1080/01443615.2017.1399260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aysegul Ozel
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ebru Alici Davutoglu
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Asuman Firat
- Department of Biochemistry, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Erenel
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Fatih Karslı
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevim Özge Korkmaz
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Riza Madazli
- Department of Obstetrics and Gynecology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
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Lowe SA, Bowyer L, Lust K, McMahon LP, Morton M, North RA, Paech M, Said JM. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015; 55:e1-29. [PMID: 26412014 DOI: 10.1111/ajo.12399] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/21/2015] [Indexed: 02/06/2023]
Abstract
This guideline is an evidence based, practical clinical approach to the management of Hypertensive Disorders of Pregnancy. Since the previous SOMANZ guideline published in 2008, there has been significant international progress towards harmonisation of definitions in relation to both the diagnosis and management of preeclampsia and gestational hypertension. This reflects increasing knowledge of the pathophysiology of these conditions, as well as their clinical manifestations. In addition, the guideline includes the management of chronic hypertension in pregnancy, an approach to screening, advice regarding prevention of hypertensive disorders of pregnancy, and discussion of recurrence risks and long term risk to maternal health. The literature reviewed included the previous SOMANZ Hypertensive Disorders of Pregnancy guideline from 2008 and its reference list, plus all other published National and International Guidelines on this subject. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT), National Institute for Health and Care Excellence (NICE) Evidence Search, and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2007 and March, 2014.
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Affiliation(s)
- Sandra A Lowe
- Department of Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Lucy Bowyer
- School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia
| | - Karin Lust
- Department of Obstetric Medicine and Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Mark Morton
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | | | - Michael Paech
- Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Joanne M Said
- Sunshine Hospital and University of Melbourne, Melbourne, Victoria, Australia
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Ernawati, Gumilar E, Kuntoro, Soeroso J, Dekker G. Expectant management of preterm preeclampsia in Indonesia and the role of steroids. J Matern Fetal Neonatal Med 2015; 29:1736-40. [PMID: 26135754 DOI: 10.3109/14767058.2015.1059815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To present the outcome of expectant management of preterm preeclampsia in Indonesia, and the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal outcome. MATERIAL AND METHODS Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration of dexamethasone for fetal lung maturation, patients were randomized to receive 25 mg MP group IV for the first week, decreasing to 12.5 mg during 2nd week and continued till birth, or matching IV placebo treatment (PL group). Prolongation of entry to delivery interval served as primary outcome measurement. RESULTS The average time gained with expectant management was almost 14 days. However, there was no difference of mean time interval between entry to delivery between the PL (13.8 days) and MP (13.7 days) groups. Antenatal ongoing treatment with IV MP also did not improve maternal and/or perinatal outcome and might be associated with a higher risk for severe maternal infections--in particular tuberculosis. CONCLUSION Expectant management of preterm preeclampsia is a realistic option in a major Indonesian perinatal referral center. Steroids (outside the use for fetal lung maturation) should not be used in the expectant management of preterm preeclampsia in Indonesia.
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Affiliation(s)
- Ernawati
- a Department of Obstetric Gynecology , Medical Faculty Airlangga University , Surabaya , Indonesia
| | - Erry Gumilar
- a Department of Obstetric Gynecology , Medical Faculty Airlangga University , Surabaya , Indonesia
| | - Kuntoro
- b Department of Statistic , Public Health Faculty Airlangga University , Surabaya , Indonesia
| | - Joewono Soeroso
- c Department of Internal Medicine , Medical Faculty Airlangga University , Surabaya , Indonesia , and
| | - Gus Dekker
- a Department of Obstetric Gynecology , Medical Faculty Airlangga University , Surabaya , Indonesia .,d Women's and Children's Division, Lyell McEwin Health Service, Medical School North , University of Adelaide , Elizabeth Vale , Australia
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Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia. Arch Gynecol Obstet 2014; 290:53-7. [PMID: 24549271 DOI: 10.1007/s00404-014-3176-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/31/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE To compare the clinical and laboratory findings and maternal-perinatal outcomes between women with early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE). METHODS One hundred and fifty-four women with preeclampsia (PE) who delivered in our clinic were included in the study. Perinatal and obstetric outcomes were evaluated. RESULTS The incidence of abnormal uterine artery (UtA) velocity waveform was significantly higher in the EO-PE group (71.4 vs 30.1 %) (p < 0.001). The incidences of small-for-gestational age, oligohydramnios, Apgar score <7 at 5 min, stillbirth and early neonatal death rates were significantly higher in women with EO-PE compared to LO-PE (p < 0.01). Maternal complications were only recorded in women with severe PE. CONCLUSION EO-PE, especially with abnormal UtA Doppler findings defines a placentation abnormality with higher perinatal adverse outcomes.
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Aoki S, Toma R, Kurasawa K, Okuda M, Takahashi T, Hirahara F. Expectant management of severe preeclampsia with severe fetal growth restriction in the second trimester. Pregnancy Hypertens 2014; 4:81-6. [DOI: 10.1016/j.preghy.2013.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/04/2013] [Accepted: 11/07/2013] [Indexed: 12/01/2022]
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Vigil-De Gracia P, Reyes Tejada O, Calle Miñaca A, Tellez G, Chon VY, Herrarte E, Villar A, Ludmir J. Expectant management of severe preeclampsia remote from term: the MEXPRE Latin Study, a randomized, multicenter clinical trial. Am J Obstet Gynecol 2013; 209:425.e1-8. [PMID: 23954534 DOI: 10.1016/j.ajog.2013.08.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 05/31/2013] [Accepted: 08/12/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether expectant management of severe preeclampsia prior to 34 weeks of gestation results in improved neonatal outcome in countries with limited resources. STUDY DESIGN This was a randomized clinical trial performed in 8 tertiary hospitals in Latin America. Criteria of randomization included gestational age between 28 and 33 weeks' gestation and the presence of severe hypertensive disorders. Patients were randomized to steroids with prompt delivery (PD group) after 48 hours vs steroids and expectant management (EXM group). The primary outcome was perinatal mortality. RESULTS A total of 267 patients were randomized, 133 to the PD group and 134 to the EXM group. Pregnancy prolongation was 2.2 days for the PD group vs 10.3 days for the EXM group (P = .0001). The rate of perinatal mortality (9.4% vs 8.7%; P = .81; relative risk [RR], 0.91; 95% confidence interval [CI], 0.34-1.93) was not improved with expectant management, and neither was the composite of neonatal morbidities (56.4% vs 55.6%; P = .89; RR, 01.01; 95% CI, 0.81-1.26). There was no significant difference in maternal morbidity in the EXM group compared with the PD group (25.2% vs 20.3%; P = .34; RR, 1.24; 95% CI, 0.79-1.94). However, small gestational age (21.7% vs 9.4%; P = .005; RR, 2.27; 95% CI, 1.21-4.14) and abruption were more common with expectant management (RR, 5.07; 95% CI, 1.13-22.7; P = .01). There were no maternal deaths. CONCLUSION This study does not demonstrate neonatal benefit with expectant management of severe preeclampsia from 28 to 34 weeks. Additionally, a conservative approach may increase the risk of abruption and small for gestational age.
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What to expect from expectant management in severe preeclampsia at <34 weeks gestation: pregnancy outcomes in developed vs developing countries. Am J Obstet Gynecol 2013; 209:400-1. [PMID: 24012482 DOI: 10.1016/j.ajog.2013.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/19/2013] [Indexed: 11/21/2022]
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Review: Potential druggable targets for the treatment of early onset preeclampsia. Pregnancy Hypertens 2013; 3:203-10. [DOI: 10.1016/j.preghy.2013.04.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 04/29/2013] [Indexed: 12/29/2022]
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Sibai BM. Evaluation and management of severe preeclampsia before 34 weeks' gestation. Am J Obstet Gynecol 2011; 205:191-8. [PMID: 22071049 DOI: 10.1016/j.ajog.2011.07.017] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We sought to review the risks and benefits of expectant management of severe preeclampsia remote from term, and to provide recommendations for expectant management, maternal and fetal evaluation, treatment, and indications for delivery. METHODS Studies were identified through a search of the MEDLINE database for relevant peer-reviewed articles published in the English language from January 1980 through December 2010. Additionally, the Cochrane Library, guidelines by organizations, and studies identified through review of the above documents and review articles were utilized to identify relevant articles. Where reliable data were not available, opinions of respected authorities were used. RESULTS AND RECOMMENDATIONS Published randomized trials and observational studies regarding management of severe preeclampsia occurring <34 weeks of gestation suggest that expectant management of selected patients can improve neonatal outcomes but that delivery is often required for worsening maternal or fetal condition. Patients who are not candidates for expectant management include women with eclampsia, pulmonary edema, disseminated intravascular coagulation, renal insufficiency, abruptio placentae, abnormal fetal testing, HELLP syndrome, or persistent symptoms of severe preeclampsia. For women with severe preeclampsia before the limit of viability, expectant management has been associated with frequent maternal morbidity with minimal or no benefits to the newborn. Expectant management of a select group of women with severe preeclampsia occurring <34 weeks' gestation may improve newborn outcomes but requires careful in-hospital maternal and fetal surveillance.
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Ganzevoort W, Sibai BM. Temporising versus interventionist management (preterm and at term). Best Pract Res Clin Obstet Gynaecol 2011; 25:463-76. [DOI: 10.1016/j.bpobgyn.2011.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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