Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors

R Astudillo; A Suy; J Alijotas-Reig; E Carreras; E Llurba; M Goya; T Higueras; L Cabero

doi:10.1016/j.preghy.2013.06.004

Expectant management in pregnant women with early and severe preeclampsia and concomitant risk factors

Pregnancy Hypertens. 2013 Oct;3(4):235-41. doi: 10.1016/j.preghy.2013.06.004. Epub 2013 Jul 16.

Authors

R Astudillo¹, A Suy², J Alijotas-Reig³, E Carreras⁴, E Llurba¹, M Goya¹, T Higueras¹, L Cabero⁵

Affiliations

¹ High Risk Obstetric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
² High Risk Obstetric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: asuy@vhebron.net.
³ Systemic Autoimmune Disease Unit, Department of Medicine I, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
⁴ Maternal Fetal Medicine Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
⁵ Obstetric Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.

PMID: 26103802
DOI: 10.1016/j.preghy.2013.06.004

Abstract

Aim: The aim of this study was to demonstrate that women with severe early-onset preeclampsia and concomitant risk factors benefit from expectant management.

Methods: This retrospective study was conducted between January 2009 and December 2010. Stable women with severe preeclampsia between 23+6 and 33+6weeks of gestation were admitted to the IOCU for conservative management. They were classified into two groups: those with concomitant risk factors, i.e. associated medical conditions, HELLP syndrome, severe oligohydramnios, fetal growth restriction and multiple pregnancies (group A) and those without (group B). P values lesser than 0.05 were considered statistically significant.

Results: No significant differences were found in maternal and perinatal outcomes between groups. Neither were differences observed in pregnancy prolongation (mean: 8.42days (SD±7.462) in group A and 10.5days (SD±8.235) in group B (p=0.391)). At the start of expectant management, 31.8% of fetuses had an abnormal middle cerebral artery Doppler; prior to delivery, this percentage was 77.4%.

Conclusion: Pregnant women with severe early-onset preeclampsia and associated risk factors benefited from expectant management. During expectant management using a continuous magnesium sulfate regimen, the majority of fetuses showed cerebral vasodilatation. The exact clinical value of this finding should be clarified in further studies.

Keywords: Eclampsia; Expectant management; HELLP syndrome; Magnesium sulfate; Risk factors; Severe preeclampsia.