LOGIN TO YOUR ACCOUNT

Username
Password
Remember Me
Or use your Academic/Social account:

CREATE AN ACCOUNT

Or use your Academic/Social account:

Congratulations!

You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.

Important!

Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message

CREATE AN ACCOUNT

Name:
Username:
Password:
Verify Password:
E-mail:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Publisher: Wiley
Languages: English
Types: Article
Subjects:
Background: Severe pre-eclampsia can cause significant mortality and morbidity for both mother and child, particularly when it occurs remote from term, between 24 and 34 weeks' gestation. The only known cure for this disease is delivery. Some obstetricians advocate early delivery to ensure that the development of serious maternal complications, such as eclampsia (fits) and kidney failure are prevented. Others prefer a more expectant approach delaying delivery in an attempt to reduce the mortality and morbidity for the child associated with being born too early.\ud Objectives: The objective of the review was to compare the effects of a policy of interventionist care and early delivery with a policy of expectant care and delayed delivery for women with early onset severe pre-eclampsia.\ud Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2013).\ud Selection criteria: Randomised trials comparing the two intervention strategies for women with early onset severe pre-eclampsia.\ud Data collection and analysis: Two review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. Data were checked for accuracy.\ud Main results: Four trials, with a total of 425 women are included in this review. Trials were at low risk of bias for methods of randomisation and allocation concealment; high risk for blinding; unclear risk for incomplete outcome data and other bias; and low risk for selective reporting. There are insufficient data for reliable conclusions about the comparative effects on most outcomes for the mother. For the baby, there is insufficient evidence for reliable conclusions about the effects on stillbirth or death after delivery (risk ratio (RR) 1.08, 95% confidence interval (CI) 0.69 to 1.71; four studies; 425 women). Babies whose mothers had been allocated to the interventionist group had more intraventricular haemorrhage (RR 1.82, 95% CI 1.06 to 3.14; one study; 262 women), more hyaline membrane disease (RR 2.30, 95% CI 1.39 to 3.81; two studies; 133 women), require more ventilation (RR 1.50, 95% CI 1.11 to 2.02; two studies; 300 women) and were more likely to have a lower gestation at birth in days (average mean difference (MD) -9.91, 95% CI -16.37 to -3.45; four studies; 425 women), more likely to be admitted to neonatal intensive care (RR 1.35, 95% CI 1.16 to 1.58) and have a longer stay in the neonatal intensive care unit (average MD 11.14 days, 95% CI 1.57 to 20.72 days; two studies; 125 women) than those allocated an expectant policy. Nevertheless, babies allocated to the interventionist policy were less likely to be small-for-gestational age (RR 0.30, 95% CI 0.14 to 0.65; two studies; 125 women). Women who had been allocated to the interventionist group were more likely to have a caesarean section (RR 1.09, 95% CI 1.01 to 1.18; four studies; 425 women) than those allocated an expectant policy. There were no statistically significant differences between the two strategies for any other outcomes.\ud Authors' conclusions: This review suggests that an expectant approach to the management of women with severe early onset pre-eclampsia may be associated with decreased morbidity for the baby. However, this evidence is based on data from only four trials. Further large trials are needed to confirm or refute these findings and establish if this approach is safe for the mother.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • GRIT 2003 {published data only} GRIT Study Group. A randomised trial of timed delivery for the compromised preterm fetus: short term outcomes and bayesian interpretation. BJOG: an international journal of obstetrics and gynaecology 2003;110:27-32. Hornbuckle J, Thornton JG, Vail A, GRIT SG. The Growth Restriction Intervention Trial (GRIT): interim progress report. Women's Health - into the new millennium. Proceedings of the 4th International Scientific Meeting of the Royal College of Obstetricians and Gynaecologists; 1999 October 3-6; Cape Town South Africa. RCOG, 1999: 76.
    • Schneider KTM, Brocker J, Thornton J. A randomised intervention of timed delivery for the compromised preterm fetus [abstract] [Randomisierte Intervention zur Optimierung des Entbindungszeitpunktes bei kompromittierten IUGR-Feten (Euro-GRIT)]. Geburtshilfe und Frauenheilkunde 2000;60 Suppl 1:S72.
    • ∗ Thornton JG, Hornbuckle J, Vail A, Spiegelhalter DJ, Levene M, GRIT study group. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet 2004;364: 513-20.
    • Walker DM, Marlow N, Upstone L, Gross H, Hornbuckle J, Vail A, et al.The Growth Restriction Intervention Trial: long-term outcomes in a randomized trial of timing of delivery in fetal growth restriction. American Journal of Obstetrics and Gynecology 2011;204(1):34.e1-9.
    • Mesbah 2003 {published data only} Mesbah EMM. Severe preterm preeclampsia: aggressive or expectant management?. Medical Journal of Cairo University 2003;71(1):175-82.
    • Odendaal 1990 {published data only} Odendaal HJ, Pattinson RC. Active or conservative treatment of severe preeclampsia - a randomized control trial. Proceedings of 37th Annual Meeting of the Society for Gynecologic Investigation; 1990 March 21-24; St Louis, USA. 1990:359.
    • ∗ Odendaal HJ, Pattinson RC, Bam R, Grove D, Kotze TJ. Aggressive or expectant management for patients with severe preeclampsia between 28-34 weeks' gestation: a randomized controlled trial. Obstetrics & Gynecology 1990;76:1070-5.
    • Sibai 1994 {published data only} Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial. American Journal of Obstetrics and Gynecology 1994;171: 818-22.
    • Gruppo di Studio1998 {published data only} Gruppo di Studio Ipertensione in Gravidanza. Nifedipine versus expectant management in mild to moderate hypertension in pregnancy. British Journal of Obstetrics and Gynaecology 1998;105:718-22.
    • Langenveld 2011 {published data only} Langenveld J, Broekhuijsen K, van Baaren GJ, van Pampus MG, van Kaam AH, Groen H, et al.Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia between 34 and 37 weeks' gestation (HYPITAT-II): A multicentre, open-label randomised controlled trial. BMC Pregnancy and Childbirth 2011;11: 50.
    • Duley 1999b Duley L, Williams J, Henderson-Smart DJ. Plasma volume expansion for treatment of pre-eclampsia. Cochrane Database of Systematic Reviews 1999, Issue 4. [DOI: 10.1002/14651858.CD001805]
    • Duley 2005 Duley L, Henderson-Smart D, Meher S. Altered dietary salt for preventing pre-eclampsia, and its complications. Cochrane Database of Systematic Reviews 2005, Issue 4. [DOI: 10.1002/14651858.CD005548]
    • Duley 2006 Duley L, Henderson-Smart DJ. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database of Systematic Reviews 2006, Issue 3. [DOI: 10.1002/ 14651858.CD001449.pub2]
    • Duley 2007 Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database of Systematic Reviews 2007, Issue 2. [DOI: 10.1002/14651858.CD004659.pub2]
    • Duley 2009 Duley L, Henderson-Smart DJ, Walker GJA. Interventions for treating pre-eclampsia and its consequences: generic protocol. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD007756]
    • Duley 2010 Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database of Systematic Reviews 2010, Issue 11. [DOI: 10.1002/ 14651858.CD000025.pub2]
    • Higgins 2005 Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5 [updated May 2005]. In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd.
    • Higgins 2011 Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
    • Hofmeyr 2010 Hofmeyr GJ, Lawrie TA, Atallah ÁN, Duley L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews 2010, Issue 8. [DOI: 10.1002/14651858.CD001059.pub3]
    • Magee 2009 Magee LA, Yong PJ, Espinosa V, Cote AM, Chen I, von Dadelszen P. Expectant management of severe preeclampsia remote from term: a structured systematic review. Hypertension in Pregnancy 2009;28(3):312-47.
    • Makrides 2001 Makrides M, Crowther CA. Magnesium supplementation in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4. [DOI: 10.1002/14651858.CD000937]
    • Morris 2012 Morris RK, Riley RD, Doug M, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. BMJ (Clinical research ed.) 2012;345:e4342. [PUBMED: 22777026]
    • RCOG 2003 Royal College of Obstetricians and Gynaecologists. Preeclampsia - study group consensus statement. http:// www.rcog.org.uk/print/womens-health/clinical-guidance/ pre-eclampsia-study-group-consensus-statement 2003.
    • RevMan 2000 The Cochrane Collaboration. Review Manager (RevMan). 4.1 for Windows. Oxford, England: The Cochrane Collaboration, 2000.
    • RevMan 2012 The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
    • Sibai 1984 Sibai BM, Spinnato JA, Watson DL, Hill GA, Anderson GD. Pregnancy outcome in 303 cases with severe preeclampsia. Obstetrics & Gynecology 1984;64:319-25.
  • No related research data.
  • No similar publications.

Share - Bookmark

Cite this article