Expectant Management of Severe Preeclampsia Remote from Term: A Structured Systematic Review

Abstract

Future research should establish the best maternal/fetal monito regimen and indications for delivery with expectant care. A definitive RCT is needed.

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Computerized NST improves perinatal outcomes compared with visual interpretation in high risk pregnancies [91]. Oligohydramnios was not predictive of adverse outcome in observational studies of preterm preeclampsia [92]. However, oligohydramnios and abnormalities of Doppler velocimetry of the umbilicial artery have been predictive of stillbirth [86].…”

“…Timing delivery will reflect evolving adverse conditions ( Table 2). Consensusderived indications for delivery are: (i) term gestation, (ii) development of severe maternal HDP-associated [92,363,368]. Currently, no tool exists to guide balancing risks, benefits, and the preferences of the woman and her family.…”

“…Following this, 40% will be considered eligible for pregnancy prolongation [92]. Expectant management should occur only in an experienced unit where neonates can be cared for at the woman's current gestational age (as delivery cannot be accurately anticipated).…”

“…Expectant management at 24 0 -33 6 weeks may decrease neonatal respiratory distress syndrome, necrotizing enterocolitis, and NICU care, despite poor fetal growth velocity during the time gained [370,371]. Rates of serious maternal complications appear very low (median < 5%) [92]. Timing of delivery should be individualized, recognizing that on average, pregnancy prolongation is 2 weeks.…”

“…Timing of delivery should be individualized, recognizing that on average, pregnancy prolongation is 2 weeks. If preeclampsia is complicated by HELLP, fewer days will be gained (median 5) and serious maternal morbidity will be higher (median 15%); >50% have temporary improvement of HELLP which may enable regional anaesthesia or vaginal delivery [92]. For late preterm preeclampsia (34 0 -36 6 weeks), delaying delivery may facilitate cervical ripening and vaginal delivery [372], but substantial perinatal benefits are not anticipated and there are concerns about the vulnerability of the fetal brain to injury at this time [373].…”