Management Of Early-onset Severe Preeclampsia Research Articles

Maternal and Neonatal Outcomes in Expectant Management of Early-Onset Severe Preeclampsia

Maternal and Neonatal Outcomes in Expectant Management of Early-Onset Severe Preeclampsia

Conservative management of early-onset severe preeclampsia: comparison between randomized and observational studies a systematic review

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.

Factors contributing to favourable neonatal outcomes in early-onset severe preeclampsia

We collected data from all the women with singleton pregnancies complicated by early-onset severe preeclampsia between 2008 and 2018 to identify the factor(s) that contributed to favourable neonatal outcome. Thirty women delivered the neonates with favourable outcome and the remaining 21 women delivered those with unfavourable outcome. Univariate logistic regression analysis revealed that gestational age at diagnosis ≥28 weeks (crude odds ratio [OR], 6.00), protocol-based management (crude OR 5.83), use of magnesium sulphate (crude OR, 6.00), gestational age at delivery ≥32 weeks (crude OR, 31.90), and birthweight ≥1000 g (crude OR, 10.36) were significantly associated with favourable neonatal outcome. Among these five factors, multivariate logistic regression analysis extracted gestational age at delivery ≥32 weeks (adjusted OR, 17.62) as an only independent factor contributing to favourable neonatal outcome. These data suggest that prolongation of pregnancy up to 32 weeks of gestation is a key factor to improve neonatal outcome in the expectant management of early-onset severe preeclampsia. This study was approved by the ethics committee of Otsu Red Cross Hospital (reference number: 363, date of approval: April 28th, 2016). Impact statement What is already known on this subject? It has been demonstrated that expectant management for the women with early-onset severe preeclampsia is associated with decreased neonatal morbidity as compared to the aggressive management, suggesting that prolongation of the pregnancy period contributes to improved neonatal outcomes. What do the results of this study add? Among multiple elements composing expectant management for the women with early-onset severe preeclampsia, ‘gestational age at delivery ≥32 weeks’ was extracted as an only independent factor that significantly contributes to favourable neonatal outcomes. Importantly, small for gestational age was not significantly associated with poor neonatal outcomes. What are the implications of these findings for clinical practice and/or further research? The obstetrician should aim to prolong the pregnancies complicated by early-onset severe preeclampsia up to 32 gestational weeks even in the presence of foetal growth restriction, as far as maternal conditions allow. Such management policy could contribute to improvement of the neonatal outcomes.

Pregnancy outcomes among women with early-onset severe preeclampsia managed conservatively

Background: Conservative management of early-onset severe preeclampsia is gaining widespread acceptance among obstetricians despite well-known maternal risks associated with it. There is limited data on the outcome of pregnancy of women managed with this modality of management in Nigerian setting. Objective: We determined the maternal and perinatal outcome of women managed conservatively for early-onset severe preeclampsia. Materials and Methods: This was a 7-year retrospective study of 118 women with early-onset severe preeclampsia that were managed conservatively at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The data were entered and analyzed using the SPSS software version 22.0 (SPSS Inc., Chicago, IL, USA). Results: The median duration of expectant management was 12 days (range 3–20 days). The mean gestational age at delivery was 33.4 ± 2.5 weeks. The most common indication for delivery was uncontrolled hypertension (35.6%). Adverse maternal outcomes found in the study included abruptio placentae (11%), acute renal failure (2.5%), pulmonary edema (0.8%), eclampsia (11.9%), disseminated intravascular coagulation (2.5%), Haemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (2.5%), and maternal death (2.5%). Perinatal mortality occurred in 68 (57.6%) cases in the study. Perinatal survival improved significantly with gestational age, with reductions in perinatal mortality of approximately 50% per week between 28 and 34 weeks' gestation on admission. Conclusion: Delayed delivery of women with early-onset severe preeclampsia improved perinatal outcome in this study, but it was associated with considerable maternal morbidity and mortality. Therefore, proper patient selection, adequate counseling of women on the risks and benefit of conservative management, close maternal monitoring, and the presence of advanced neonatal care are necessary to optimize pregnancy outcome when this management modality is adopted.

Expectant management of early-onset severe preeclampsia: a principal component analysis.

Preeclampsia is a multisystem disorder that is characterized by hypertension with either proteinuria or end-organ dysfunction in both previously normotensive women and chronically hypertensive women. To identify the important influencing factors for early-onset severe preeclampsia, this study undertook to explore the associations between preeclampsia characteristics, along with the decreased latency and poor neonatal outcomes during expectant management of severe preeclampsia before 34 weeks of gestation. A total of 213 patients were retrospectively studied. Pregnancy outcomes in terms of maternal complications and neonatal outcomes were determined. Statistical analysis was performed by principal component analysis, Student's t-test, and Pearson correlation analysis. Neonatal mortality was influenced by gestational age at delivery and birth weight. The main factors that influenced pregnancy outcome were gestational age at diagnosis, the 24-h urine protein level, the plasma albumin level, and hydrothorax plus ascites. When the gestational age at diagnosis was 25 weeks, and 4/7 days, the probability that the pregnancy would be classified into group 2 with 79.3% neonatal survival was almost 50%. Only the plasma albumin level and hydrothorax plus ascites affected prolongation. Plasma albumin level and hydrothorax plus ascites should be considered seriously, as they may be a reason to terminate the expectant management of early-onset severe preeclampsia. Given its unsatisfactory pregnancy outcomes, expectant management should be reconsidered before 25 weeks and 4/7 days.

Risk factors for cardiopulmonary dysfunction in early-onset severe pre-eclampsia

ObjectiveTo explore associations between patient characteristics and cardiopulmonary function among patients with early-onset severe pre-eclampsia being treated with expectant management. MethodThe present retrospective study included patients who received expectant management for early-onset pre-eclampsia between January 1 and December 31, 2014 at Shanghai Jiao Tong University School of Medicine, China. Patients were divided into two groups based on cardiopulmonary function, a decompensatory group and a normal group. The clinical characteristics of patients in the two groups were compared by binary logistic regression analysis and using the Student t test. ResultsData from 93 patients were included in the analysis. Serum creatinine levels (P=0.017), ascites (P=0.001), and increased proteinuria (P=0.015) were associated with decompensation of cardiopulmonary function during early-onset severe pre-eclampsia. Hypoproteinemia was associated with significantly increased odds of ascites occurring (odds ratio 3.16; 95% confidence interval 1.34–7.44) and the mean serum albumin level was higher in patients without ascites (P<0.001). ConclusionsRenal insufficiency and ascites were associated with cardiopulmonary dysfunction. Ascites should receive greater medical attention during the expectant management of early-onset severe pre-eclampsia.

Clinical trial of expectant management of severe preeclampsia that develops at

Objective: This study was to examine the clinical usefulness of expectant management of early-onset severe preeclampsia.Methods: We reviewed the obstetric records of all Japanese singleton deliveries at ≥22 weeks’ gestation managed at Japanese Red Cross Katsushika Maternity Hospital between 2007 and 2012. We compared the obstetric characteristics and perinatal outcomes between the cases of deliveries before (n = 19) and after completion of corticosteroids (n = 30) (immediate delivery versus expectant management).Results: Although the gestational age at delivery in the patients expectantly managed was higher than that in the patients required immediate deliveries (31.0 versus 29.3 weeks), the difference in the incidence of neonatal respiratory distress syndrome between the two groups did not reach the statistical significance (74 versus 47%, p = 0.06). The incidence of pulmonary edema in the patients expectantly managed was significantly higher than that in the patients required immediate deliveries within the first 48 h (20 versus 0%, p = 0.04).Conclusion: The current results could not support the clinical usefulness of expectant management of early-onset severe preeclampsia.

Using heparin and low-dose aspirin in expectant management of early-onset severe preeclampsia

When you face a case of early-onset severe preeclampsia, the definitive treatment is termination of pregnancy, but it is often at the expense of fetal outcome. Thus, expectant management has arisen in the recent literature as a treatment option. As thrombophilia is implicated in many adverse pregnancy outcomes, blood thinners such as heparin and low-dose aspirin have been introduced as a part of expectant management in this article.

Risk factors of adverse pregnancy outcomes during expectant management of early onset severe pre-eclampsia

To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups: the favorable pregnancy outcome group (control, n = 101) and the adverse pregnancy outcome group (n = 35). The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed. (1) General clinical information: more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs. 57.1%, P < 0.05). No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI), proportion of women who had regular antenatal checks (P > 0.05). (2) Pregnant outcomes: the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 +/- 8.2) days vs. (6.8 +/- 10.0) days, P > 0.05]. The main complications in the adverse outcome group included placental abruption (n = 13), heart failure and pulmonary edema (n = 10), hemolysis, elevated liver enzymes and low platelet syndrome (HELLP syndrome, n = 5), and no eclampsia was reported. However, none of these complications was reported from the control group. (3) Blood pressure and proteinuria: the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 +/- 3.4) weeks vs. (33.0 +/- 4.9) weeks, (32.1 +/- 3.0) weeks vs. (34.0 +/- 3.6) weeks, P < 0.05], the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+++) were also much higher in the adverse outcome group (all P < 0.05). (4) Hemodynamics and routine blood tests: the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P < 0.05). But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P > 0.05). The adverse outcome group showed lower platelet (PLT) level and higher red blood cell (RBC) count and hematocrit compared with those of the control (all P < 0.01). (5) Liver and renal function: the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), blood urea nitrogen (BUN) in the adverse outcome group were significantly higher than those of the control group (all P < 0.05), but the plasma level of total protein (TP), albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups (P > 0.05). (6) Risk factor analysis: RBC count (OR = 3.68, 95%CI: 1.90-7.13), PLT count (OR = 0.99, 95%CI: 0.98-1.00) and the gestations at delivery (OR = 0.87, 95%CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP. Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.

Is expectant management of early-onset severe preeclampsia worthwhile in low-resource settings?

To evaluate the maternal and perinatal outcome following expectant management of early-onset severe preeclampsia (PE) at a tertiary hospital in Mansoura, Egypt. This prospective, observational study included 211 patients with severe PE, occurring between 24 and 34 weeks of gestation. They were classified according to gestational age on admission into three groups. Group 1 included 61 patients with gestational ages between 24 and 28 weeks. Group 2 (28 to <32 weeks) included 66 patients and group 3 (32-34 weeks) included 84 patients. Outcome measures included prolongation of gestation, and maternal and perinatal complications. The median overall prolongation of gestation was 12 +/- 6 days. The rate of neonatal survival significantly increased (P < 0.001) from 12/61 (19.7%) in group 1 to 30/66 (45.5%) in group 2 and 67/84 (79.8%) in group 3. There were no maternal mortalities; however, 43 (20.4%) women developed significant morbidities. HELLP syndrome, renal impairment and placental abruption were the main complications. In low-resource settings, expectant management of early-onset severe PE is associated with relatively higher rates of perinatal mortality and maternal morbidity and should be limited to gestational ages between 28 and 34 weeks of gestation.

Pre-eclampsia-eclampsia 1996

The fetal and maternal morbidity and mortality associated with hypertension complicating pregnancy primarily results from pre-eclampsia. This review focuses on recent developments in the areas of prevention and management. It specifically analyses studies designed to determine whether low-dose aspirin or calcium supplements, taken throughout pregnancy, reduce the incidence of pre-eclampsia, a debate on whether we have been too aggressive in terminating pregnancies in patients with severe pre-eclampsia remote from term, and the efficacy of parenteral magnesium sulfate in the prevention or treatment, or both, of the eclamptic convulsion. We conclude that neither aspirin nor calcium appears to improve the gestational outcome, although large trials currently under way may alter this view. The debate on 'conservative' versus aggressive management of early-onset severe pre-eclampsia seems to be more apparent than real. After years of acrimonious debate there are data to support the superiority of magnesium over phenytoin to prevent pre-eclampsia and the efficacy of the drug in reducing recurrent convulsions in eclampsia. However, whether 'prophylactic' therapy is indeed necessary or whether blood pressure control alone will prevent eclampsia remains to be determined.