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Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation
David Churchill1, Lelia Duley, Jim G Thornton
1Department of Obstetrics and Gynaecology, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wednesfield, Wolverhampton, West Midlands, UK, WV10 0QP.
The Cochrane Database of Systematic Reviews
|October 6, 2018
Summary
An expectant approach to managing severe pre-eclampsia in early pregnancy may reduce infant morbidity. However, more research is needed to confirm these findings and ensure maternal safety.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Severe pre-eclampsia poses significant risks to both mother and child, especially when occurring between 24 and 34 weeks' gestation.
- Delivery is the only cure, but timing is debated: early delivery to prevent maternal complications versus delayed delivery to improve infant outcomes.
- The study addresses the critical decision of management strategy for severe early-onset pre-eclampsia.
Purpose of the Study:
- To compare the benefits and risks of early delivery versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation.
- To evaluate outcomes for both mother and infant under different management strategies.
- To inform clinical decision-making regarding the optimal timing of delivery.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing early delivery with expectant care for severe early-onset pre-eclampsia.
- Inclusion of trials with abstract reporting and cluster-trial designs; exclusion of quasi-randomized trials.
- Independent assessment of trials for inclusion, risk of bias, data extraction, and quality assessment using the GRADE approach.
Main Results:
- Insufficient data for reliable conclusions on maternal outcomes; no maternal deaths reported in included studies.
- Infants born to mothers managed with expectant care showed reduced intraventricular hemorrhage and respiratory distress.
- Expectant care was associated with lower rates of being small-for-gestational age, but longer neonatal intensive care unit stays were observed.
- No significant differences were found for perinatal deaths or admission to neonatal intensive care.
Conclusions:
- An expectant management approach for severe early-onset pre-eclampsia may be associated with decreased infant morbidity.
- The current evidence is based on a limited number of trials, necessitating further large, high-quality studies.
- Future research should aim to confirm these findings and establish the maternal safety of expectant care.