Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation

Churchill, David; Duley, Lelia; Thornton, Jim; Moussa, Mahmoud; Ali, Hind Sm; Walker, Kate F.

doi:10.1002/14651858.cd003106.pub3

Cited by 36 publications

(40 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This supports the recent observation that, in an ovine model of high altitude fetal growth restriction, maternal melatonin significantly prolonged pregnancy . Prolongation of pregnancy by 6 days may be clinically significant in women presenting with preeclampsia at preterm gestations, such as the women in this trial, with each additional day of pregnancy conferring improvements in perinatal morbidity and mortality . That said, we did not observe any differences in composite perinatal outcome between the babies in this trial and historic controls, albeit numbers were very small and not adequate to address such outcomes.…”

Section: Discussionsupporting

confidence: 89%

Melatonin improves endothelial function in vitro and prolongs pregnancy in women with early‐onset preeclampsia

Hobson

Gurusinghe

Lim

et al. 2018

Journal of Pineal Research

123

111

View full text Add to dashboard Cite

Preeclampsia remains a leading cause of maternal and perinatal morbidity and mortality. There have been no material advances in the treatment of preeclampsia for nearly 50 years. Combining in vitro studies and a clinical trial, we aimed to determine whether melatonin could be a useful adjuvant therapy. In a xanthine/xanthine oxidase (X/XO) placental explant model, melatonin reduced oxidative stress (8-isoprostane) and enhanced antioxidant markers (Nrf2 translocation, HO-1), but did not affect explant production of anti-angiogenic factors (sFlt, sEng, activin A). In cultured HUVECs, melatonin mitigated TNFα-induced vascular cell adhesion molecule expression and rescued the subsequent disruption to endothelial monolayer integrity but did not affect other markers for endothelial activation and dysfunction. In a phase I trial of melatonin in 20 women with preeclampsia, we assessed the safety and efficacy of melatonin on (i) preeclampsia progression, (ii) clinical outcomes, and (iii) oxidative stress, matching outcomes with recent historical controls receiving similar care. Melatonin therapy was safe for mothers and their fetuses. Compared to controls, melatonin administration extended the mean ± SEM diagnosis to delivery interval by 6 ± 2.3 days reduced the need for increasing antihypertensive medication on days 3-4 (13% vs 71%), days 6-7 (8% vs 51%), and at delivery (26% vs 75%). All other clinical and biochemical measures of disease severity were unaffected by melatonin. We have shown that melatonin has the potential to mitigate maternal endothelial pro-oxidant injury and could therefore provide effective adjuvant therapy to extend pregnancy duration to deliver improved clinical outcomes for women with severe preeclampsia.

show abstract

Section: Discussionsupporting

confidence: 89%

Melatonin improves endothelial function in vitro and prolongs pregnancy in women with early‐onset preeclampsia

Hobson

Gurusinghe

Lim

et al. 2018

Journal of Pineal Research

123

111

View full text Add to dashboard Cite

show abstract

“…Churchill et al . reported that there is insufficient evidence to reach a reliable conclusion about the effects of neonatal death after delivery (RR, 1.33; 95%CI: 0.80–2.23; four studies; 425 pregnancies) …”

Section: Discussionmentioning

confidence: 99%

Impact of pre‐eclampsia in extremely premature infants: Population‐based study

Tokumasu

Kawakami

2016

Pediatrics International

View full text Add to dashboard Cite

show abstract

“…Definitive treatment for pre‐eclampsia is the delivery of the fetus. Maternal and fetal risks must be evaluated before a pregnancy is interrupted . Predicting the probability of morbidity and mortality serves to direct care and resources to patients most likely to develop complications …”

Section: Introductionmentioning

confidence: 99%

Validation of fullPIERS model for prediction of adverse outcomes among women with severe pre‐eclampsia

Almeida

Katz

Coutinho

et al. 2017

Intl J Gynecology & Obste

View full text Add to dashboard Cite

show abstract

Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation

Abstract: Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation.

Cited by 36 publications

References 34 publications

Melatonin improves endothelial function in vitro and prolongs pregnancy in women with early‐onset preeclampsia

Melatonin improves endothelial function in vitro and prolongs pregnancy in women with early‐onset preeclampsia

Impact of pre‐eclampsia in extremely premature infants: Population‐based study

Validation of fullPIERS model for prediction of adverse outcomes among women with severe pre‐eclampsia

Contact Info

Product

Resources

About