EXPECTANT MANAGEMENT OF

PREECLAMPSIA WITH SEVERE

FEATURES

Ratna C.S Dewi

TOPIC SELECTING WOMEN WITH PREECLAMPSIA

WITH SEVERE FEATURES FOR PROMPT DELIVERY
VERSUS EXPECTANT MANAGEMENT

Rationale for delaying delivery reduce perinatal morbidity and mortality by delivery of
a more mature fetus and, to a lesser degree, to achieve a more favorable cervix for
vaginal birth.

Preeclampsia proteinuria or end-organ dysfunction after 20 weeks of gestation in a

previously normotensive woman

In 2013, the American College of Obstetricians and Gynecologists replaced the term
severe preeclampsia with the term preeclampsia with severe features.

Pulmonary
edema

Renal :
creatinine >
1,1 mg/dL

New-onset
cerebral or
visual
disturbances

Severe
featur
e preeclam
sia

epigastric
pain

BP : 160/110

Impaired
liver function

Thrombocito
penia (<
100.000/ml)

The term
preeclam
psia with
severe fea
ture
used when a s is
n
the feature y of
s listed
in the fo
llowing
table are p
resent

INCIDENCE

database of hospital discharge data from approximately 300,000 deliveries in the United
States found the overall incidence of preeclampsia with severe features was
approximately 1 percent of all pregnancies

nulliparous women 5% preeklamsi and 40-50% women develop features of severe

disease

preeclampsia with severe features < 34 weeks 0.3 %

CONSEQUENCES

Maternal complications seizures, pulmonary edema, hypertensive encephalopathy,

stroke, renal failure, hepatic failure or rupture, retinal detachment or cortical blindness,
disseminated intravascular coagulation, placental abruption, and death

The major consequences of severe preeclampsia were increased rates of maternal liver
and kidney dysfunction, induced labor, cesarean delivery, preterm birth, fetal growth
restriction, and neonatal respiratory problems.

Early onset has a poorer prognosis than late onset.

Gestasional
Gestasional
age
age

fetal
fetal

Mother
Mother
factor
factor

Pre eclamsia

CONSEQUENCES OF EXPECTANT MANAGEMENT

BY GESTATIONAL AGE
The gestational age reflects the time of onset of expectant management.

BETWEEN 25 AND 34 WEEKS OF GESTATION

EXPECTANT MANAGEMENT TO APPROPRIATELY
SELECTED WOMEN

Second trimester
25-63%
Pregnancies 28
weeks
25 and 34 weeks
of gestation

have serious complications, including HELLP syndrome, renal

insufficiency, placental abruption, pulmonary edema, and
eclampsia.

24-34 weeks of gestatonal : Pre-eclampsia Eclampsia Trial Amsterdam (PETRA) study

mean gestational age at delivery 31,4 weeks increased frequency of IQ and Fifty-four
percent of the children had normal results on all tests of developmental outcome

Women with preeclampsia with severe features who have reached a favorable gestational
age (34 weeks of gestation),

Expectant management for patients with preeclampsia with severe features presenting
between 24 and 34 weeks of gestation in the following circumstances:

Preeclampsia with severe features based on transient laboratory abnormalities

alone :
Asymptomatic preeclampsia with severe features by laboratory criteria alone (alanine and
aspartate aminotransferase [ALT, AST] 2 x, platelet count less than 100,000
cells/microL).

Preeclampsia with severe features based on blood pressure criteria alone :

Antihypertensive agents are given to control severe hypertension

CONTRAINDICATIONS

Maternal hemodynamic instability (shock)

estimated fetal weight less than the fifth percentile for gestational age, oligohydramnios

Intrapartum fetal demise

Persistent severe hypertension unresponsive to medical therapy

Severe headache

Eclampsia

Pulmonary edema

Renal failure

Placental abruption

Laboratory
Aminotransferases
platelet <100,000 cells/microL
Coagulopathy in the absence of an alternative explanation

Preterm labor

Preterm premature rupture of membranes

Maternal request for immediate delivery

HELLP syndrome

INITIAL MANAGEMENT
Suspected Preeclampsia Hospital

Admission to the Labor and Delivery Unit.

Antenatal corticosteroids

Seizure prophylaxis with magnesium sulfate

Blood pressure monitoring at least every one to two hours

Accurate recording of fluid intake and urine output.

Laboratory

Assessment of fetal well-being,

COMPONENTS OF EXPECTANT MANAGEMENT

Hospitalize until delivery

Monitor blood pressure

Frequently assess maternal symptoms

Intake and urine output oliguria

Laboratory

Antenatal corticosteroids

Assessment of fetal well-being

Continue magnesium sulfate

Consultation

Maternal
indication
Fetal
indication

Obstetrical
indiation

Delivery

ANESTHESIA
Sc 28-30 WEEKS OF GESTATION

neuraxial anesthetic techniques

spinal anesthesia

Epidural anesthesia

For pregnancies 34 weeks of gestation, we suggest prompt delivery

For pregnancies <24 weeks of gestation, we suggest prompt delivery

Expectant management is associated with a high risk of severe maternal morbidity, perinatal
mortality, and severe neonatal morbidity.
Severe hypertension should be treated with antihypertensive drugs to reduce the risk of
stroke.