Vázquez-Rodríguez JG, Barboza-Alatorre DY

Language: Spanish
References: 21
Page: 379-386
PDF size: 1152.74 Kb.

ABSTRACT

Introduction: In severe preeclampsia (SP), pregnancy interruption is the first recommendation. However, some patients receive expectant treatment.
Objective: To determine maternal and perinatal results of expectant treatment of SP in the intensive care unit (ICU) of a high-specialty hospital.
Methods: Observational, descriptive and retrospective study; the files of 40 pregnant patients with SP managed in the ICU with expectant treatment were reviewed. The prolongation of the pregnancy, the maternal and perinatal complications, the stay in ICU and in the hospital were recorded. Descriptive statistics were used for statistical analysis.
Results: Mean maternal age was 30.2 ± 5.04 years and gestational age 30.02 ± 3.18 weeks. Gestation was prolonged 7.5 ± 0.95 days. Maternal complications occurred in 60% (24 cases): thrombocytopenia 48.9%, HELLP syndrome 17.8%, pulmonary edema 4.45%, acute kidney injury 4.45%, deterioration of chronic kidney disease 4.45%, oligohydramnios 4.45%, uterine hemorrhage 4.45%, platelet transfusion 4.45%, eclampsia 2.2%, intravascular coagulation 2.2%, surgical reintervention 2.2%, without mortality. ICU stay was 3.42 ± 1.85 days and hospital stay 8.8 ± 4.82 days. 41 premature newborns were treated (100%) and complications were reported in 74.20% (23 cases): respiratory insufficiency 53.65%, neonatal intensive care 39.02%, growth restriction 21.95%, unreliable fetal status 9.75% and mortality 24.39%. Intensive care stay was 8.5 ± 5.47 days and hospital stay 26.8 ± 23.2 days.
Conclusions: Prolongation of pregnancy was similar to what has been reported in previous studies. Due to the high percentage of maternal and perinatal complications, expectant treatment is not recommended.

REFERENCES

1. World Health Organization. WHO Recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva, Switzerland: WHO; 2011. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK140561/

2. American College of Obstetricians and Gynecologists (ACOG). Task Force on hypertension in pregnancy. Washington, DC: ACOG; 2013: pp. 1- 89. Disponible en: http://www.acog.org/Resources-And-Publications/Task- Force-and-Work-Group Reports/Hypertension-in-Pregnancy

3. Pridjian G, Puschett JB. Preeclampsia. Part 1: Clinical and pathophysiologic considerations. Obstet Gynecol Surv. 2002;57(9):598-618.

4. ACOG Practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Int J Gynaecol Obstet. 2002;77(1):67-75.

5. Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010;376(9741):631-644.

6. Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol. 2013;25(2):124-132.

7. Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol. 2007;196(6):514.e1-9.

8. Koopmans CM, Bijlenga D, Aarnoudse JG, van Beek E, Bekedam DJ, van den Berg PP, et al. Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preeclampsia at term: the HYPITAT trial. BMC Pregnancy Childbirth. 2007;7:14-22.

9. Lineamiento técnico. Prevención, diagnóstico y manejo de la preeclampsia-eclampsia. Secretaria de Salud. Dirección General de Medicina Reproductiva. México. 2007.

10. Guía de Práctica Clínica GPC. Prevención, diagnóstico y tratamiento de la preeclampsia en el segundo y tercer nivel de atención. Ciudad de México, México: Secretaría de Salud; 2017. Disponible en: http://www.cenetec.salud.gob.mx/contenidos/gpc/catalogo MaestroGPC.html

11. Churchill D, Duley L. Interventionist versus expectant care for severe pre-eclampsia before term. Cochrane Database Syst Rev. 2002;3:CD003106.

12. Coppage K, Polzin WJ. Severe preeclampsia and delivery outcomes: is immediate cesarean delivery beneficial? Am J Obstet Gynecol. 2002;186(5):921-923.

13. Abdel-Hady el-S, Fawzy M, El-Negeri M, Nezar M, Ragab 2 A, Helal AS. Is expectant management of early-onset severe preeclampsia worthwhile in low-resource settings? Arch Gynecol Obstet. 2010;282(1):23-27.

14. Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks’ gestation: a randomized controlled trial. Am J Obstet Gynecol. 1994;171(3):818-822.

15. Briones-Garduño JC, Díaz de León-Ponce M, González- Vargas A, Briones-Vega CG. Resultados perinatales con tratamiento conservador en la preeclampsia-eclampsia. Reporte preliminar. Cir Cir. 2003;71(2):112-115.

16. Sarsam DS, Shamdem M, Al Wazan R. Expectant versus aggressive management in severe preeclampsia remote from term. Singapore Med J. 2008;49(9):698-703.

17. Vigil-De Gracia P, Reyes Tejada O, Calle Miñaca A, Téllez G, Yuen Chon V, Herrarte E, et al. Expectant management of severe preeclampsia remote from term: the MEXPRE Latin Study, a randomized, multicenter clinical trial. Am J Obstet Gynecol. 2013;209:425.e1-8.

18. Loi K, Khoo C, Tan KH, Yeo GSH, Kwek K. A review of 93 cases of severe preeclampsia in Singapore: are there risk factors for complications? Singapore Med J. 2007;48(9):808-812.

19. Vijgen S, Koopmans CM, Opmeer BC, Groen H, Bijlenga D, Aarnoudse JG, et al. (HYPITAT study group). An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or pre-eclampsia at term (HYPITAT trial). BJOG. 2010;117(13):1577-1585.

20. Royal College of Obstetricians & Gynaecologists. The management of hypertensive disorders during pregnancy. NICE Clinical Guidelines. London, UK: RCOG Press; 2011. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK62652/

21. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Canadian Hypertensive Disorders of Pregnancy Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can. 2014;35:416-441. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/24927294