he Amsterdam randomized study reported by Ganzevoort and coworkers (2005a,b) was a well-designed investigation done to evaluate volume expansion. A total of216 women with severe preeclampsia were enrolled between 24 and 34 weeks' gestation. he study included women whose preeclampsia was complicated by HELLP syndrome, eclampsia, or fetal-growth restriction. In the group randomly assigned to volume expansion, each woman was given 250 mL of 6-percent hydroxyethyl starch infused over 4 hours twice daily. heir outcomes were compared with a control group, and none of these outcomes were significantly diferent (Table 40-13). Importantly, serious maternal morbidity and a substantive perinatal mortality rate accompanied their "expectant" management (see Table 40-9).
Pulmonary edema 2.9
Placental abruption 3.8 l.0
Prolongation of pregnancy (mean) 11n.6 d 6.7 d
EGA at death (mean) 26.7 wk 26.3 wk
Prolongation of pregnancy (mean) 10.5 d 7.4 d
EGA at delivery (mean) 31.6 wk 31.4 wk
Neonatal death (%) 7.6 8.1 0.05.
EGA = estimated gestational age; HELLP = hemolysis, elevated liver enzyme levels, low platelet count; RDS = respiratory distress syndrome.
Data from Ganzevoort, 2005a, b.
• Neuroprophylaxis-Prevention of Seizures aL studies, magnesium suate was reported to be superior to the Several randomized trials have tested the eicacy of seizure comparator agent to prevent eclampsia. Four of the larger studies prophylxis for women with gestational hypertension, with or are summarized in Table 40-14. In the study from Parland without proteinuria. In most of these, magnesium sulfate was Hospital, magnesium sulfate therapy was superior to phenycompared with another anticonvulsant or with a placebo. In toin to prevent eclamptic seizures in women with gestational
TABLE 40-14. Randomized Comparative Trials of Prophylaxis with Magnesium Sulfate and Placebo or Another Anticonvulsant in Women with Gestational Hypertension
No. with Seizures/Total No. Treated (%)
Gestational hypertensionb 0/1n049 (0) 10/1n089 (0.9) P < 0.001
Severe preeclampsia 1/345 (0.3) 1n1/340 (3.2) RR = 0.09 (0.1-0.69)
Severe preeclampsia 40/5055 (0.8) 96/5055 (1n.9) RR = 0.42 (0.26-0.60)
Severe preeclampsia 7/831 (0.8) 21/819 (2.6) RR = 0.33 (0.14-0.77) aAIl comparisons significant p < 0.05.
blncluded women with and without proteinuria and those with all severities of preeclampsia. (Magpie Trial Collaboration Group, 2002.
RR = relative risk.
hypertension or preeclampsia (Lucas, 1995). In another, magnesium sulfate and nimodipine-a calcium-channel blocker with specific cerebral vasodilator activity-were compared in 1650 women with severe preeclampsia (Belfort, 2003). The rate of eclampsia was more than threefold higher for women allocated to the nimodipine group-2.6 versus 0.8 percent.