Expectant or outpatient management of preeclampsia before 34 weeks: safe for mother but associated with increased stillbirth risk

Today the only effective “treatment” for preeclampsia is to deliver at the optimal time for both maternal and foetal well-being. Studies reported that severe preeclampsia can benefit from the expectant management including mild preeclampsia between 34 and 37 weeks. However it is unclear whether mild preeclampsia before 34 weeks also benefits from the expectant management. Data on 274 women with mild preeclampsia before 37 weeks of gestation were retrospectively collected and analysed. Blood pressure and proteinuria at time of onset were not clinically associated with delivery time. For women who developed preeclampsia before 34 weeks, the median latency from onset to delivery or from onset to admission to hospital or from admission to hospital to delivery was 27 or 21 or 3 days, respectively. There were four women (2%) who delivered within 48 h after onset, 28 (14%) FGR and 14 (7%) stillbirths. The median birth-weight was 2240 g. For women who developed preeclampsia between 34 and 37 weeks, the median latency from onset to delivery or from onset to admission to hospital or from admission to hospital to delivery was 11 or 7 or 2 days, respectively. There were seven women (10%) who delivered within 48 h after onset and eight (12%) FGR. The median birth-weight was 2880 g. Our study demonstrates that mild preeclampsia before 37 weeks has benefits from expectant or outpatient management with a median prolongation of over 11 days dependent on the time of onset, but it increases the risk for stillbirths before 34 weeks.