Interventionist versus expectant care for severe pre‐eclampsia before term
Abstract
Background
Severe pre‐eclampsia can cause significant mortality and morbidity for both mother and child, particularly when it occurs well before term. The only known cure for this disease is delivery. Some obstetricians advocate early delivery to prevent the development of serious maternal complications, such as eclampsia (fits) and kidney failure. Others prefer a more expectant approach in an attempt to delay delivery and, hopefully, reduce the mortality and morbidity for the child associated with being born too early.
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.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2006) and the Cochrane Controlled Trials Register (The Cochrane Library 2006, Issue 2). We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 1 December 2009 and added the results to the awaiting classification section.
Selection criteria
Randomised trials comparing the two intervention strategies for women with early onset severe pre‐eclampsia.
Data collection and analysis
Both review authors independently extracted and checked data.
Main results
Two trials (133 women) are included in this review. There are insufficient data for reliable conclusions about the comparative effects on outcome for the mother. For the baby, there is insufficient evidence for reliable conclusions about the effects on stillbirth or death after delivery (relative risk (RR) 1.50, 95% confidence interval (CI) 0.42 to 5.41). Babies whose mothers had been allocated to the interventionist group had more hyaline membrane disease (RR 2.30, 95% CI 1.39 to 3.81), more necrotising enterocolitis (RR 5.54, 95% CI 1.04 to 29.56) and were more likely to need admission to neonatal intensive care (RR 1.32, 95% CI 1.13 to 1.55) than those allocated an expectant policy. Nevertheless, babies allocated to the interventionist policy were less likely to be small‐for‐gestational age (RR 0.36, 95% CI 0.14 to 0.90). There were no statistically significant differences between the two strategies for any other outcomes.
Authors' conclusions
There are insufficient data for any reliable recommendation about which policy of care should be used for women with severe early onset pre‐eclampsia. Further large trials are needed.
[Note: The citation in the awaiting classification section of the review may alter the conclusions of the review once assessed.]
PICOs
Plain language summary
Interventionist versus expectant care for severe pre‐eclampsia before term
Little evidence exists to show whether early delivery is better than expectant care for women who suffer from severe pre‐eclampsia before 34 weeks of pregnancy.
Women who develop early onset pre‐eclampsia (high blood pressure and protein in the urine) and their unborn babies, are at risk of severe complications and even death. The only known cure for pre‐eclampsia is delivery of the baby and placenta. However, being born too early can in itself have problems for the baby, even with the administration of corticosteroids to help mature the baby's lungs. This review found that there is not enough evidence from the trials performed to recommend either early delivery or expectant care for women with severe pre‐eclampsia before 34 weeks of pregnancy.
