Ganzevoort (2005a, b) 216 11 1.8 18 3.6 NS 1.8
Bombrys (2009) 66 5 11 8 9 3 0 27 1.5
Abdel-Hady (2010) 211 12 3.3 7.6 0.9 6.6 0.9 NS 48 Vigil-De Gracia (2013) 131 10.3 7.6 14 1.5 4.5 0.8 22 8.7
Range 91n0 5-1n2 1.8-23 4.6-27 0.9-3.9 2.3-6.6 0.9-1n8 27-94 1.5-48 alncludes one maternal death.
AKI = acute kidney injury; EGA = estimated gestational age; FGR = fetal-growth restriction; HELLP = hemolysis, elevated liver enzyme levels, low platelet count syndrome; NS = not stated; PMR = perinatal mortality rate; Pulm. = pulmonary.
9 percent in each group, the composite neonatal morbidity outcome was not improved with expectant management. On the other hand, fetal-growth restriction-22 versus 9 percent-and placental abruption-7.6 versus 1.5 percent-were significantly higher in the group managed expectantly.
Expectant Management of Midtrimester Severe Preeclampsia
Several small studies have focused on expectant management of severe preeclampsia syndrome bore 28 weeks. In their review, Bombrys and coworkers (2008) found eight such studies that included nearly 200 women with severe preeclampsia with an onset <26 completed weeks. Maternal complications were common. Because no neonates survived when delivered before 23 weeks, the Task Force (2013) recommends pregnancy termination in these cases. For women with slightly more advanced pregnancies, however, the decision is less clear. For example, at 23 weeks' gestation, the perinatal survival rate was 18 percent, but long-term perinatal morbidity is yet unknown. For women with pregnancies at 24 to 26 weeks, perinatal survival approached 60 percent, and it averaged almost 90 percent for those at 26 weeks.
At least five observational studies of women with severe midtrimester preeclampsia who were managed expectantly have been published since 2005 (AbdelHady, 2010; Belghiti, 2011; Bombrys,
Admit to L&D
Contraindications to conservative management
Eclampsia, pulmonary edema, HELLP syndrome
Significant renal dysfunction, coagulopathy
Frequent evaluation: vital signs, UOP
Serial lab evaluation of re n.aI function and for HELLP syndrome
Daily fetal assessment and evaluation of serial growth and amnionic fluid
FIGURE 40-14 Clinical management algorithm for severe preeclampsia at <34 weeks. HELLP = hemolysis, elevated liver enzyme levels, low platelet count; L&D = labor and delivery; MgS04= magnesium sulfate; UOP = urine output. (Adapted from the Society for 2008; Budden, 2006; Gaugler-Senden, Maternal-Fetal Medicine, 2011.) 2006). Maternal complications developed in 60 percent, and there was one maternal death. he perinatal mortality rate was 650 per 1000 births. At this time, no comparative studies attest to perinatal benefits of such expectant treatment versus early delivery in the face of serious maternal complications, which approach rates of 50 percent. We do not recommend such management.