Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation

• Published in: Cochrane database of systematic reviews 2013-07 (7), p.CD003106-CD003106
• Main Authors: Churchill, David, Duley, Lelia, Thornton, Jim G, Jones, Leanne
• Format: Article
• Language: English
• Subjects: Cesarean Section - statistics & numerical data; Delivery, Obstetric - adverse effects; Delivery, Obstetric - methods; Enterocolitis, Necrotizing - etiology; Female; Humans; Hyaline Membrane Disease - etiology; Infant, Newborn; Pre-Eclampsia - therapy; Pregnancy; Randomized Controlled Trials as Topic; Watchful Waiting
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD003106.pub2

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. 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. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2013). Randomised trials comparing the two intervention strategies for women with early onset severe pre-eclampsia. Two review authors independently assessed trials for inclusion, extracted data and assessed risk of bias. Data were checked for accuracy. 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 inte