Expectant management of severe preeclampsia with severe fetal growth restriction in the second trimester

Aoki, Shigeru; Toma, Rie; Kurasawa, Kentaro; Okuda, Masahiko; Takahashi, Tsuneo; Hirahara, Fumiki

doi:10.1016/j.preghy.2013.11.006

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…When combining the data, 34% of the live‐born neonates experienced respiratory distress syndrome (2 studies, range 34%‐36%), 9.1% had bronchopulmonary dysplasia (4 studies, range 4%‐19%), 4.3% had intraventricular hemorrhage (10 studies, range 0%‐25%), 5.6% had necrotizing enterocolitis (9 studies, range 0%‐22%), 2.6% had persistent pulmonary hypertension of the newborn (2 studies, range 1.9%‐9.1%), 12.5% had retinopathy of prematurity (4 studies, range 2%‐29%) and 30% had sepsis (4 studies, range 25%‐64%). One study used a composite outcome for severe neonatal morbidity and 1 study used a composite for respiratory distress syndrome and chronic lung disease …”

Section: Resultsmentioning

confidence: 99%

Early‐onset fetal growth restriction: A systematic review on mortality and morbidity

Pels

Beune

Wassenaer-Leemhuis

et al. 2019

Acta Obstet Gynecol Scand

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Introduction: Severe early-onset fetal growth restriction is an obstetric condition with significant risks of perinatal mortality, major and minor neonatal morbidity, and long-term health sequelae. The prognosis of a fetus is influenced by the extent of prematurity and fetal weight. Clinical care is individually adjusted. In literature, survival rates vary and studies often only include live-born neonates with missing rates of antenatal death. This systematic review aims to summarize the literature on mortality and morbidity. Material and methods: A broad literature search was conducted in OVID MEDLINE from 2000 to 26 April 2019 to identify studies on fetal growth restriction and perinatal death. Studies were excluded when all included children were born before 2000 because (neonatal) health care has considerably improved since this period. Studies were included that described fetal growth restriction diagnosed before 32 weeks of gestation and antenatal mortality and neonatal mortality and/or morbidity as outcome. Quality of evidence was rated with the GRADE instrument. Results: Of the 2604 publications identified, 25 studies, reporting 2895 pregnancies, were included in the systematic review. Overall risk of bias in most studies was judged as low. The quality of evidence was generally rated as very low to moderate, except for 3 large well-designed randomized controlled trials. When combining all data on mortality, in 355 of 2895 pregnancies (12%) the fetus died antenatally, 192 died in the neonatal period (8% of live-born neonates) and 2347 (81% of all pregnancies) children survived. Of the neonatal morbidities recorded, respiratory distress syndrome (34% of the live-born neonates), retinopathy of prematurity (13%) and sepsis (30%) were most common. Of 476 children that underwent neurodevelopmental assessment, 58 (12% of surviving children, 9% of all pregnancies) suffered from cognitive impairment and/or cerebral palsy. Conclusions:When combining the data of 25 included studies, survival in fetal growth restriction pregnancies, diagnosed before 32 weeks of gestation, was 81%.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Resultsmentioning

confidence: 99%

Early‐onset fetal growth restriction: A systematic review on mortality and morbidity

Pels

Beune

Wassenaer-Leemhuis

et al. 2019

Acta Obstet Gynecol Scand

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“…The patients were managed as previously detailed . Delivery was performed upon detection of conditions such as maternal organ dysfunction, nonreassuring fetal status, or severe, treatment‐resistant hypertension or, in the case of severe PE, when 34 weeks’ gestation was reached.…”

Section: Methodsmentioning

confidence: 99%

Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

Tochio

Obata

Saigusa

et al. 2019

J of Obstet and Gynaecol

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Aims: The Japanese Society for the Study of Hypertension in Pregnancy revised the diagnostic criteria for pre-eclampsia (PE) to conform to those of the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018. This study aimed to investigate whether pregnancy outcomes differ based on the presence of proteinuria and validate the adoption of the ISSHP criteria in Japan. Methods: This is a retrospective study involving 308 women diagnosed with hypertensive disorders of pregnancy at a tertiary center. They were divided into the following groups: PE with proteinuria (n = 218), PE without proteinuria (n = 45) and gestational hypertension (n = 45) according to the ISSHP criteria for comparison of pregnancy outcomes. Results: Applying the ISSHP criteria increased the number of pregnant women diagnosed as having PE by 14.6% (45 women). The difference in the rate of composite maternal complications between the two groups was unremarkable, with 33 cases (15.1%) in the PE with proteinuria group and 9 cases (20%) in the PE without proteinuria group. Moreover, composite neonatal complications occurred in 37 cases (17%) of PE with proteinuria group and 6 cases (13.3%) of PE without proteinuria group, showing remarkably similar incidence rate in the two groups. Women with PE with and without proteinuria had significantly earlier deliveries and lower neonatal birth weight than those with gestational hypertension. Conclusion: Pregnancy outcomes of PE with and without proteinuria were almost similar although their incidence increased, confirming its validity for adaptation of the ISSHP criteria in Japan.

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“…[70][71][72] It has also been reported that the presence of fetal growth restriction in women with severe preeclampsia decreases perinatal survival independently of other factors. 73,74 However, the interpretation of these data are frequently hampered by the imprecision in fetal growth restriction diagnosis and constitutional variations. Focusing on fetal size parameters in isolation to detect compromise is a grossly oversimplified approach.…”

Section: Toward a New Frameworkmentioning

confidence: 99%

Preeclampsia: The Need for a Biological Definition and Diagnosis

2020

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The centuries-old approach to the prevention of eclampsia and its associated maternal morbidity and mortality is based on the recognition of the presence of premonitory signs and symptoms such as hypertension and proteinuria. The spectrum of preceding signs and symptoms came to be known as preeclampsia, which is debatably considered to be an early stage on a clinical continuum possibly leading to eclampsia. The premonitory signs and symptoms were then construed as diagnostic criteria for the poorly understood syndrome of preeclampsia, and this led to a perpetual debate that remains subject to wide disagreement and periodic updates. In this commentary, we will draw attention to the fact that the criteria for preeclampsia should be viewed from the prism of a screening test rather than as diagnostic of a condition in itself. Focusing research on developing better diagnostic and screening methods for what is clinically important, namely maternal and perinatal morbidity and mortality from hypertensive disorders of pregnancy, a long overdue upgrade from what was possible centuries ago, will ultimately lead to better management approaches to what really matters.

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Expectant management of severe preeclampsia with severe fetal growth restriction in the second trimester

Cited by 8 publications

References 14 publications

Early‐onset fetal growth restriction: A systematic review on mortality and morbidity

Early‐onset fetal growth restriction: A systematic review on mortality and morbidity

Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

Preeclampsia: The Need for a Biological Definition and Diagnosis

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