Expectant /conservative management of severe preeclampsia far from term

Abstract

Severe preeclampsia that develops at <34 weeks of gestation is associated with high perinatal
mortality and morbidity rates. Management with immediate delivery leads to high neonatal
mortality and morbidity rates and prolonged hospitalization in the neonatal intensive
care unit because of prematurity. Conversely, attempts to prolong pregnancy with expectant
management may result in fetal death or asphyxia damage in utero and increased maternal
morbidity. Expectant care has been compared with interventionist care in three randomized
controlled trials (RCTs) that enrolled 400 women. Interventionist care was associated with
more respiratory distress syndrome but similar neonatal intensive care unit (NICU) admission
and neonatal mortality. Expectant care was associated with a mean pregnancy prolongation
of 1-2 weeks, but more small for gestational age (SGA) infants and abruptio placentae. Women
with severe preeclampsia before 34 weeks may benefit from stabilization on a 48-72 hour
period, to enable maximal effect of antenatal corticosteroids and delivery. Women with severe
preeclampsia between 24-28 weeks may benefit from effect of antenatal corticosteroids
and observation with possible expectant management and delivery due to maternal o fetal
conditions.
Keywords: Expectant management, severe preeclampsia at <34 weeks of gestation, eclampsia,
perinatal mortality.