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

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Maternal-Fetal Medicine

Background:

• Severe pre-eclampsia poses significant risks to mothers and infants, especially when occurring between 24 and 34 weeks' gestation.
• Delivery is the only cure, leading to debate between early intervention and delayed delivery to mitigate risks.

Purpose of the Study:

• To compare the outcomes of interventionist care with early delivery versus expectant care with delayed delivery for severe early-onset pre-eclampsia.

Main Methods:

• Systematic review of randomized controlled trials from the Cochrane Pregnancy and Childbirth Group's Trials Register.
• Two independent reviewers assessed trial inclusion, data extraction, and risk of bias.

Main Results:

• Four trials involving 425 women were included. Data on maternal outcomes were insufficient.
• Infants in the interventionist group showed increased intraventricular hemorrhage, hyaline membrane disease, and ventilation needs.
• Infants in the interventionist group had lower gestational age at birth and longer neonatal intensive care unit stays, but were less likely to be small-for-gestational age. Maternal C-section rates were higher.

Conclusions:

• An expectant management approach for severe early-onset pre-eclampsia may reduce infant morbidity.
• Evidence is limited due to small trial numbers; further large trials are necessary to confirm findings and assess maternal safety.