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[Evidence-based obstetric conduct. Severe preeclampsia: aggressive or expectant management?]
Carlos Briceño Pérez1, Liliana Briceño Sanabria
1Departamento de Ginecología y Obstetricia, Facultad de Medicina de la Universidad del Zulia, Maracaibo, Venezuela. cabriceno@cantv.net
Ginecologia Y Obstetricia De Mexico
|June 5, 2007
Summary
Expectant management for severe preeclampsia remote from term may prolong pregnancy without increasing maternal risks. However, more extensive trials are needed for definitive recommendations on this approach.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Severe preeclampsia necessitates timely delivery, but management strategies for cases remote from term remain debated.
- Historically, hospitalization was agreed upon, but consensus on expectant versus aggressive management was lacking.
Purpose of the Study:
- To review evidence-based medicine comparing expectant and aggressive management for severe preeclampsia remote from term.
- To summarize current recommendations and proposals for expectant management in this patient group.
Main Methods:
- Review of fifteen non-randomized, non-controlled trials and four Latin American studies on pregnancy prolongation.
- Analysis of two randomized controlled trials evaluating expectant management outcomes.
- Inclusion of systematic review findings and guidelines from US national groups.
Main Results:
- Non-randomized trials suggested 10-14 day pregnancy prolongation with conservative management, but lacked robust methodology.
- Randomized controlled trials indicated improved neonatal outcomes with expectant management, without increased maternal morbidity.
- A systematic review found insufficient data for reliable recommendations, highlighting the need for longer trials.
Conclusions:
- Expectant management in severe preeclampsia remote from term shows potential for improved neonatal outcomes.
- Current evidence is insufficient for definitive recommendations, necessitating further research.
- Guidelines suggest expectant management is feasible for selective patients (23-32 weeks) in specialized settings.
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