Expectant Management of Severe Preeclampsia Remote from Term : A Hospital-Based Survey

Introduction: The management of severe preeclampsia remote from term is one of the most difficult challenges in obstetrics. Delivery at a very low gestational age increases the risk for adverse neonatal outcomes, and the attempt to prolong pregnancy in order to improve neonatal outcomes is suggested in selected cases. We aimed to assess the real feasibility and effectiveness of expectant management of early onset severe preeclampsia in a routine clinical setting. Materials and methods: The study included 194 patients with severe preeclampsia between 24-34 weeks’ gestation; the primary outcome measure was perinatal outcome according to management. Results: Sixty-four women were delivered during or immediately after stabilization and 130 patients underwent expectant management. Median gestational age at onset was significantly lower in patients who underwent expectant management (29 vs. 31 weeks; p<0.001). Median gestational age at delivery in both groups was 31 weeks’ gestation. Mean prolongation of pregnancy in the expectant management group was 7 days (range 4-19). The longest prolongation of pregnancy was recorded in patients with the lowest gestational age. The perinatal/neonatal outcomes between the two groups were similar. The most common indications for delivery in both groups were uncontrolled maternal hypertension and HELLP syndrome. Conclusions: Expectant management of severe preeclampsia remote from term is feasible in a routine clinical setting, and it is effective particularly at the lowest gestational ages. The definition of the proper length of prolongation of pregnancy and the target gestational age to reach require further investigation.