Expectant management in severe preeclampsia remote from term (24-33.6 weeks): experience in a high complexity center

Authors

  • Nevardo Calderon Restrepo Universidad Pontificia Bolivariana
  • Ánderson Pérez Muñoz Clínica del Prado - Clínica SOMA
  • Jorge Hernán Gutiérrez Marín Universidad Pontificia Bolivariana
  • José Enrique Sanín Blair Universidad Pontificia Bolivariana
  • Raúl Alejando García Posada Universidad Pontificia Bolivariana
  • Diana Paola Cuesta Universidad Pontificia Bolivariana
  • Maria Nazareth Campo Campo Universidad Pontificia Bolivariana

DOI:

https://doi.org/10.21615/cesmedicina.6881

Keywords:

preeclampsia, severe remote pregnancy preeclampsia, expectant management, maternal and perinatal morbility

Abstract

Introduction: severe preeclampsia before 34 weeks of gestational age has a high risk of maternal and fetal complications. Expectant management could decrease the risk of complications associated with premature birth. Objective: to evaluate the efficacy of expectant management in the prevention of maternal and perinatal adverse events of patients with severe preeclampsia remote from term. Methodology: a retrospective cohort study in pregnant women diagnosed with severe preeclampsia between 24 and 33.6 weeks of gestational age who were admitted in a Colombian high complexity medical center between 2011 and 2019 was carried out. Descriptive measurements of the expectant management and the interventionist management were compared and the association with maternal and neonatal composite outcomes. Results were adjusted by gestational age under 28 weeks of delivery. Results: 134 patients were analyzed; 110 patients with expectant management and 24 interventionist management. Expectant management had a lower probability of cesarean section (RR 0.79 CI95% 0.69-0.91) and maternal composite result (RR 0.67 CI95% 0.57-0.79) that did not persist after the adjustment. Expectant management had a lower probability of APGAR <7 the first minute (21.6% vs. 40%, RR 0.53 CI95% 0.29-0.97) and neonatal composite result (60% vs. 83.3%, RR 0.72 CI95% 0.57-0.90). When adjusting the age under 28 weeks of delivery, the expectant management showed a lower probability of APGAR under 7 at minute one (RR 0.43 CI95% 0.24-0.75), composite outcome of perinatal adverse events (RR 0.62 CI95% 0.48-0.81), neonatal death (RR 0.26 CI95% 0.29-0.71), respiratory distress syndrome (RR 0.65 CI95% 0.48-0.88), intraventricular hemorrhage (RR 0.31 CI95% 0.11-0.89) and admission to the neonatal intensive care unit (RR 0.80 CI95% 0.70-0.92). Conclusion: severe preeclampsia remote from term is a severe and complex disease which faces maternal and neonatal interests. Due to approach controversies, management should be performed in high complexity centers with a multidisciplinary approach individualizing each binomial; our findings suggest expectant management is reasonable when both maternal and fetal conditions allow it, especially in pregnancies under 28 weeks of gestational age to improve fetal outcomes without risking maternal outcomes.

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Author Biographies

Nevardo Calderon Restrepo, Universidad Pontificia Bolivariana

Médico Ginecólogo y Obstetra. Universidad Pontificia Bolivariana, Medellín, Colombia.

Ánderson Pérez Muñoz, Clínica del Prado - Clínica SOMA

Especialista en cirugía endoscópica ginecológica FUCS. Cirugía endoscópica Clínica del Prado y Clínica SOMA, Medellín, Colombia.

Jorge Hernán Gutiérrez Marín, Universidad Pontificia Bolivariana

Especialista en medicina materno-fetal. Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.

José Enrique Sanín Blair, Universidad Pontificia Bolivariana

Especialista en medicina materno-fetal. Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.

Raúl Alejando García Posada, Universidad Pontificia Bolivariana

Especialista en medicina materno-fetal. Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.

Diana Paola Cuesta, Universidad Pontificia Bolivariana

MSc Epidemiología, PhD Epidemiología, Universidad Pontificia Bolivariana, Medellín, Colombia.

Maria Nazareth Campo Campo, Universidad Pontificia Bolivariana

Especialista en medicina materno-fetal. Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia.

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Portada Revista CES Medicina Vol 36 no. 3 2022

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Published

2022-11-16

How to Cite

Calderon Restrepo, N., Pérez Muñoz, Ánderson, Gutiérrez Marín, J. H., Sanín Blair, J. E., García Posada, R. A., Cuesta, D. P., & Campo Campo, M. N. (2022). Expectant management in severe preeclampsia remote from term (24-33.6 weeks): experience in a high complexity center. CES Medicina, 36(3), 38–51. https://doi.org/10.21615/cesmedicina.6881

Issue

Vol. 36 No. 3 (2022): CES Medicina

Section

Artículo original de investigación científica o tecnológica

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