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Cited by 458Pregnancy and preeclampsia studiesNeurological Complications and SyndromesNeonatal and fetal brain pathology

Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks’ gestation: a randomized controlled trial

Sibai, Baha M., Mercer, Brian M., Schiff, Eyal, Friedman, Steven A.·1994·American Journal of Obstetrics and Gynecology
DOI 10.1016/0002-9378(94)90104-x
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Abstract

Objective Our purpose was to determine whether aggressive or expectant management of severe preeclampsia at 28 to 32 weeks is more beneficial to maternal and neonatal outcome.Study design Ninety-five eligible patients were randomly assigned to either aggressive (n = 46) or expectant management (n = 49). Aggressive management patients were prepared for delivery, either by cesarean or induction, 48 hours after glucocorticoids were administered. Expectant management patients were managed with bed rest, oral antihypertensives, and intensive antenatal fetal testing.Results At the time of randomization there were no differences between the two groups in mean systolic blood pressure (170 +/- 9.7 vs 172 +/- 9.4 mm Hg), diastolic blood pressure (110 +/- 5.4 vs 112 +/- 4.2 mm Hg), proteinuria (3.0 +/- 2.3 vs 3.6 +/- 2.3 gm per 24 hours), and gestational age (30.4 +/- 1.6 vs 30.7 +/- 1.5 weeks) for the aggressive and expectant management groups. The average latency period in the expectant management group was 15.4 days (range 4 to 36), and this period was not affected by the amount of proteinuria at randomization. There was no eclampsia or perinatal death in either group. The two groups had similar incidences of abruptio placentae (4.1% vs 4.3%) and similar days of postpartum hospital stay. The expectant management group had a significantly higher gestational age at delivery (32.9 +/- 1.5 vs 30.8 +/- 1.7 weeks, p < 0.0001), higher birth weight, lower incidence of admission to the neonatal intensive care unit (76% vs 100%, p = 0.002), lower mean days of hospitalization in the intensive care unit (20.2 +/- 14 vs 36.6 +/- 17.4, p < 0.0001), and lower incidence of neonatal complications.Conclusion Expectant management, with close monitoring of mother and fetus at a perinatal center, reduces neonatal complications and neonatal stay in the newborn intensive care unit.

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Crossref · 10.1016/0002-9378(94)90104-x

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  • The only RCTs that evaluated activity restriction in preeclampsia compared bed rest with immediate delivery, a design that precludes independent analysis of activity restriction as an intervention.

    “However, the only RCTs that have evaluated activity restriction in the setting of preeclampsia compared bed rest with immediate delivery—a study design that precludes independent analysis of activity restriction as an intervention.23,24”

    From Society for Maternal-Fetal Medicine Consult Series #50: The role of activity restriction in obstetric management (2020) · cites this paper as [24]

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Authors
Sibai, B. M., Mercer, B. M., Schiff, E., & Friedman, S. A.
Affiliations
University of Tennessee Health Science Center (US)
Corresponding author
Sibai, Baha M.
ORCID
Sibai, Baha M.
Venue
American Journal of Obstetrics and Gynecology
Publisher
Elsevier BV
Published
1994-09
Volume
171
Issue
3
Pages
818-822
ISSN
0002-9378 (ISSN-L)
DOI
10.1016/0002-9378(94)90104-x
OpenAlex
W1981398964
Cited by
458
References
17
Citations by year
2026: 6 · 2025: 4 · 2024: 11 · 2023: 26 · 2022: 12 · 2021: 10 · 2020: 24 · 2019: 14 · 2018: 12 · 2017: 7 · 2016: 13 · 2015: 17 · 2014: 15 · 2013: 20 · 2012: 14
FWCI
10.44
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
Keywords
severe preeclampsia, expectant management, early-onset preeclampsia, glucocorticoids, antihypertensive therapy, fetal monitoring, perinatal outcomes, neonatal intensive care, placental abruption, gestational age at delivery, birth weight, neonatal complications, maternal blood pressure, proteinuria, cesarean section, labor induction
MeSH terms
Adolescent, Adult, Analysis of Variance, Antihypertensive Agents, Bed Rest, Birth Weight, Cesarean Section, Female, Fetal Monitoring, Gestational Age, Glucocorticoids, Humans, Infant, Newborn, Infant, Newborn, Diseases, Intensive Care Units, Neonatal, Labor, Induced, Length of Stay, Pre-Eclampsia, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, Third, Chi-Square Distribution

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