Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: A randomized controlled trial

Sibai, Baha M.; Mercer, Brian M.; Schiff, Eyal; Friedman, Steven A.

doi:10.1016/0002-9378(94)90104-x

Cited by 409 publications

(210 citation statements)

References 9 publications

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“…The days of pregnancy prolongation observed in this study are in agreement with the results of recent trials [10][11][12]. Two prospective randomized controlled trials comparing expectant management with interventionist management have been published [5,6]. The first study that included 38 patients found a mean pregnancy prolongation of 7.1 days in the group of women who were given expectant management [5].…”

Section: Discussionsupporting

confidence: 89%

“…One randomized trial has shown an improvement of perinatal outcome without deterioration of maternal condition. This study, however, had a limited sample size [6]. This study was undertaken to determine maternal and perinatal outcomes after expectant management of singleton pregnancies with severe pre-eclampsia between 24 and 34 weeks of gestation at a tertiary care center.…”

Section: Introductionmentioning

confidence: 99%

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Maternal and Perinatal Outcome During Expectant Management of Severe Pre-Eclampsia Between 24 and 34 Weeks of Gestation

Swamy

Patil

Shailaja

2012

J Obstet Gynecol India

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Objective To determine the maternal and perinatal outcome after expectant management of severe pre-eclampsia between 24 and 34 weeks of gestation. Method The maternal and fetal status was monitored by an intensive, non-invasive method among 94 women with severe pre-eclampsia between 24 and 34 weeks of gestation who were scheduled for expectant management in the OICU at a tertiary care center. Pregnancy prolongation and maternal and perinatal morbidity and mortality were analyzed by the Student 't' test and the Mann-Whitney U test. Results The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at \30 weeks. Increasing gestational age correlated with a reduction of RDS. Maternal morbidities were significantly higher among those managed at\28 weeks. But, there was no maternal mortality. Conclusion Expectant management of severe preeclampsia at 30-34 weeks in a tertiary care center of a developing country is associated with good perinatal outcome and risk reduction for the mother.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Maternal and Perinatal Outcome During Expectant Management of Severe Pre-Eclampsia Between 24 and 34 Weeks of Gestation

Swamy

Patil

Shailaja

2012

J Obstet Gynecol India

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“…The finding of an increasing incidence of growth restriction and asymmetric growth at more advanced GA and with longer expectant management is in line with other studies 4,5 and is of concern since both have been identified as predictors of survival in previous studies 5 and indicated poorer outcome in this cohort ( 16,20,33,34 the placentocerebral ratio preceding delivery was higher in pregnancies with poor outcome or major morbidity and showed a stronger association than middle cerebral artery PI alone. When controlling for the fetal weight estimation, the placentocerebral ratio was no longer significantly associated with the end points studied.…”

Section: Redistributionsupporting

confidence: 88%

“…In the two randomized controlled trials that showed an improved outcome with expectant management in severe preterm pre-eclampsia, 3,4 no detailed ultrasound and Doppler data were presented. This study shows that abnormal initial Doppler waveforms as well as the closely linked ultrasound features of placental insufficiency (asymmetry, oligohydramnios, SGA) predicted a shorter interval to delivery, this getting progressively shorter as more vessels showed abnormal waveforms, as reported before.…”

Section: Interval To Deliverymentioning

confidence: 99%

“…1,2 Expectant management is feasible in selected cases, but only considered when it may significantly reduce prematurity-related compromise 3,4 although fetal indications for delivery in pre-eclampsia are not well established. Placental insufficiency often complicates pre-eclampsia and may cause fetal distress, hypoxaemia, metabolic acidosis, perinatal demise, morbidity and long-term impairment.…”

Section: Introductionmentioning

confidence: 99%

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Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

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The Hypertensive Disorders of Pregnancy

Leeman

Dresang

Fontaine

1954

JAMA

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Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: A randomized controlled trial

Cited by 409 publications

References 9 publications

Maternal and Perinatal Outcome During Expectant Management of Severe Pre-Eclampsia Between 24 and 34 Weeks of Gestation

Maternal and Perinatal Outcome During Expectant Management of Severe Pre-Eclampsia Between 24 and 34 Weeks of Gestation

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

The Hypertensive Disorders of Pregnancy

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