Guidelines for the management of women with severe pre-eclampsia

Bonnet, Marie‐Pierre; Garnier, Marc; Keïta, H.; Compère, Vincent; Arthuis, Chloé; Raia-Barjat, Tiphaïne; Berveiller, Paul; Burey, Julien; Bouvet, Lionel; Bruyère, M.; Castel, Adeline; Clouqueur, É.; Estevez, Max Gonzalez; Faitot, Valentina; Fuchs, Florent; Lecarpentier, Édouard; Gouez, Agnès Le; Rigouzzo, A.; Rossignol, Mathias; Simon, Émilie; Vial, F.; Vivanti, Alexandre J.; Zieleskiewicz, Laurent; Sénat, Marie-Victoire; Schmitz, Thomas; Sentilhes, Loïc

doi:10.1016/j.accpm.2021.100901

Cited by 23 publications

(2 citation statements)

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“…However, although the national guidelines for pre-eclampsia management were updated in 2021 [16], we believe the analysis of the quality of care assessed from the EPIMOMS data, and the opportunities for improvement identified, are still relevant. Indeed, the recent guidelines are similar to the previous ones for the components of care assessed in our analysis, except for the prophylactic use of magnesium sulphate [10], which is now recommended for even broader clinical symptoms not restricted to neurological signs, as in the most recent international guidelines [17][18][19][20][21][22]. Future studies should be conducted to assess if professionals modify their practices to adopt these new recommendations.…”

Section: Plos Onementioning

confidence: 74%

Population-based study of eclampsia: Lessons learnt to improve maternity care

Korb,

Azria,

Sauvegrain

et al. 2024

PLoS ONE

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Background Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. Objective 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. Methods It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012–2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. Results The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0–4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. Conclusion The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP.

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Section: Plos Onementioning

confidence: 74%

Population-based study of eclampsia: Lessons learnt to improve maternity care

Korb,

Azria,

Sauvegrain

et al. 2024

PLoS ONE

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“…The results of our up-to-date synthesis of available evidence provide a rigorous evidence base for trustworthy clinical practice guidelines for the management of HELLP syndrome. [35][36][37][38][39][40][41] Limitations A limitation of the evidence was the restricted number of outcomes reported in the included trials. Most included trials reported surrogate laboratory results.…”

Section: Summary Of the Evidencementioning

confidence: 99%

Corticosteroids for improving patient relevant outcomes in HELLP syndrome: a systematic review and meta-analysis

Kasem,

Alqenawy,

Elgendi

et al. 2023

Preprint

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ObjectivesWe conducted an update of systematic review to assess the effects of corticosteroids vs placebo or no treatment for improving patient relevant outcomes in hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome.DesignA systematic review and meta-analysis of randomized controlled trials.Data sourcesCENTRAL, MEDLINE/PubMed, Web of Science, and Scopus from the date of inception of the databases to September 20, 2023. The reference lists of included studies and other systematic reviews were thoroughly searched.Eligibility criteriaWe included randomized controlled trials that enrolled women with HELLP syndrome, whether antepartum or postpartum, to receive any corticosteroid versus placebo or no treatment. No restrictions on language or date of publication were made.Data extraction and synthesisWe used a dual independent approach for screening titles and abstracts, full text screening, data extraction and risk of bias assessment. Pairwise meta-analyses were conducted, where two or more studies met methodological criteria for inclusion. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess certainty for the pre-specified important outcomes.ResultsFifteen trials (821 women) compared corticosteroids with placebo or no treatment. The effect of corticosteroids is uncertain for the primary outcome i.e., maternal death (risk ratio 0.77, 95% confidence interval 0.25 to 2.38, very low certainty evidence). The effect of corticosteroids is also uncertain for other important outcomes including pulmonary edema, dialysis, liver morbidity (hematoma, rupture, and failure), or perinatal death because of very low certainty evidence. Low certainty evidence suggests that corticosteroids have little or no effect on the need for platelet transfusion (risk ratio 0.9821; 95% confidence interval 0.6031 to 1.5994) and may result in a slight reduction in acute renal failure (risk ratio 0.6658; 95% confidence interval 0.3965 to 1.1179)ConclusionIn women with HELLP syndrome, the effect of corticosteroids vs placebo or no treatment is uncertain for patient relevant outcomes including maternal death, maternal morbidity, and perinatal death.Article summaryStrengths and limitations of this studyWe used robust systematic review and meta-analysis methods.We synthesized results on patient relevant outcomes that are critical for decision making.The available evidence was associated with limitations related to the small sample size of included trials, different timing to initiate corticosteroids administration, and reporting bias.Outcomes assessed using the Grading of Recommendations, Assessment, Development and Evaluation framework were judged to have very low certainty of evidence due to extremely serious imprecision.

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Intensivmedizin in der Geburtshilfe

Neuhaus¹,

Bremerich²

2023

Praxis Der Intensivmedizin

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Guidelines for the management of women with severe pre-eclampsia

Cited by 23 publications

References 133 publications

Population-based study of eclampsia: Lessons learnt to improve maternity care

Population-based study of eclampsia: Lessons learnt to improve maternity care

Corticosteroids for improving patient relevant outcomes in HELLP syndrome: a systematic review and meta-analysis

Intensivmedizin in der Geburtshilfe

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