W Visser1, H C Wallenburg. 1. Erasmus University School of Medicine and Health Science, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands.
Abstract
OBJECTIVE: To assess maternal and perinatal outcomes of expectant management with plasma volume expansion and pharmacologic vasodilatation in patients with severe pre-eclampsia remote from term. STUDY DESIGN: All women with severe pre-eclampsia between 20 and 32 weeks' gestation, not in labor and with a live, single fetus admitted to the University Hospital Rotterdam from 1985 to 1993 were managed with the intention to prolong gestation. Treatment consisted of correction of the maternal circulation with vasodilatation by means of dihydralazine and plasma volume expansion under central hemodynamic monitoring. Primary end-points of the study were prolongation of gestation, maternal antepartum and postpartum complications, and fetal and neonatal outcome. RESULTS: Two-hundred fifty-four patients were included. The median prolongation of pregnancy was 14 (range 0-62) days. Hemodynamic treatment was associated with marked objective and subjective improvement in maternal condition. Complications of central hemodynamic monitoring were not observed. Perinatal mortality was 20.5%. CONCLUSION: Expectant management with plasma volume expansion and pharmacologic vasodilatation under central hemodynamic monitoring of the maternal circulation may delay delivery and enhance fetal maturity and does not appear to be associated with an increased risk of maternal morbidity and mortality.
OBJECTIVE: To assess maternal and perinatal outcomes of expectant management with plasma volume expansion and pharmacologic vasodilatation in patients with severe pre-eclampsia remote from term. STUDY DESIGN: All women with severe pre-eclampsia between 20 and 32 weeks' gestation, not in labor and with a live, single fetus admitted to the University Hospital Rotterdam from 1985 to 1993 were managed with the intention to prolong gestation. Treatment consisted of correction of the maternal circulation with vasodilatation by means of dihydralazine and plasma volume expansion under central hemodynamic monitoring. Primary end-points of the study were prolongation of gestation, maternal antepartum and postpartum complications, and fetal and neonatal outcome. RESULTS: Two-hundred fifty-four patients were included. The median prolongation of pregnancy was 14 (range 0-62) days. Hemodynamic treatment was associated with marked objective and subjective improvement in maternal condition. Complications of central hemodynamic monitoring were not observed. Perinatal mortality was 20.5%. CONCLUSION: Expectant management with plasma volume expansion and pharmacologic vasodilatation under central hemodynamic monitoring of the maternal circulation may delay delivery and enhance fetal maturity and does not appear to be associated with an increased risk of maternal morbidity and mortality.
Authors: Arif Aktuğ Ertekin; Bilge Kapudere; Meryem Kurek Eken; Gülşah İlhan; Şükriye Dırman; Mehmet Akif Sargın; Engin Deniz; Güner Karatekin; Ebru Çöğendez; Murat Api Journal: Int J Clin Exp Med Date: 2015-10-15
Authors: Kartik K Venkatesh; Robert A Strauss; Daniel J Westreich; John M Thorp; David M Stamilio; Katherine L Grantz Journal: Pregnancy Hypertens Date: 2020-03-10 Impact factor: 2.899