Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review

Detalhes bibliográficos
Autor(a) principal: Guida,José Paulo de Siqueira
Data de Publicação: 2017
Outros Autores: Surita,Fernanda Garanhani, Parpinelli,Mary Angela, Costa,Maria Laura
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista brasileira de ginecologia e obstetrícia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032017001100622
Resumo: Abstract Introduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between arterial hypertension and proteinuria or evidence of severity. There are unanswered questions in the literature considering the timing of delivery once preterm preeclampsia has been diagnosed, given the risk of developingmaternal complications versus the risk of adverse perinatal outcomes associated with prematurity. The objective of this systematic review is to determine the best timing of delivery for women diagnosed with preeclampsia before 37 weeks of gestation. Methods Systematic literature review, performed in the PubMed database, using the terms preeclampsia, parturition and timing of delivery to look for studies conducted between 2014 and 2017. Studies that compared the maternal and perinatal outcomes of women who underwent immediate delivery or delayed delivery, in the absence of evidence of severe preeclampsia, were selected. Results A total of 629 studies were initially retrieved. After reading the titles, 78 were selected, and their abstracts, evaluated; 16 were then evaluated in full and, in the end, 6 studies (2 randomized clinical trials and 4 observational studies) met the inclusion criteria. The results were presented according to gestational age range (< 34 weeks and between 34 and 37 weeks) and by maternal and perinatal outcomes, according to the timing of delivery, considering immediate delivery or expectant management. Before 34 weeks, thematernal outcomeswere similar, but the perinatal outcomes were significantly worse when immediate delivery occurred. Between 34 and 37 weeks, the progression to severe maternal disease was slightly higher among women undergoing expectant management, however, with better perinatal outcomes. Conclusions When there is no evidence of severe preeclampsia or impaired fetal wellbeing, especially before 34 weeks, the pregnancy should be carefully surveilled, and the delivery, postponed, aiming at improving the perinatal outcomes. Between 34 and 37 weeks, the decision on the timing of delivery should be shared with the pregnant woman and her family, after providing information regarding the risks of adverse outcomes associated with preeclampsia and prematurity.
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spelling Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Reviewpreeclampsiadeliveryprematuritypreterm preeclampsiaAbstract Introduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between arterial hypertension and proteinuria or evidence of severity. There are unanswered questions in the literature considering the timing of delivery once preterm preeclampsia has been diagnosed, given the risk of developingmaternal complications versus the risk of adverse perinatal outcomes associated with prematurity. The objective of this systematic review is to determine the best timing of delivery for women diagnosed with preeclampsia before 37 weeks of gestation. Methods Systematic literature review, performed in the PubMed database, using the terms preeclampsia, parturition and timing of delivery to look for studies conducted between 2014 and 2017. Studies that compared the maternal and perinatal outcomes of women who underwent immediate delivery or delayed delivery, in the absence of evidence of severe preeclampsia, were selected. Results A total of 629 studies were initially retrieved. After reading the titles, 78 were selected, and their abstracts, evaluated; 16 were then evaluated in full and, in the end, 6 studies (2 randomized clinical trials and 4 observational studies) met the inclusion criteria. The results were presented according to gestational age range (< 34 weeks and between 34 and 37 weeks) and by maternal and perinatal outcomes, according to the timing of delivery, considering immediate delivery or expectant management. Before 34 weeks, thematernal outcomeswere similar, but the perinatal outcomes were significantly worse when immediate delivery occurred. Between 34 and 37 weeks, the progression to severe maternal disease was slightly higher among women undergoing expectant management, however, with better perinatal outcomes. Conclusions When there is no evidence of severe preeclampsia or impaired fetal wellbeing, especially before 34 weeks, the pregnancy should be carefully surveilled, and the delivery, postponed, aiming at improving the perinatal outcomes. Between 34 and 37 weeks, the decision on the timing of delivery should be shared with the pregnant woman and her family, after providing information regarding the risks of adverse outcomes associated with preeclampsia and prematurity.Federação Brasileira das Sociedades de Ginecologia e Obstetrícia2017-11-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0100-72032017001100622Revista Brasileira de Ginecologia e Obstetrícia v.39 n.11 2017reponame:Revista brasileira de ginecologia e obstetrícia (Online)instname:Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO)instacron:FEBRASGO10.1055/s-0037-1604103info:eu-repo/semantics/openAccessGuida,José Paulo de SiqueiraSurita,Fernanda GaranhaniParpinelli,Mary AngelaCosta,Maria Lauraeng2017-12-21T00:00:00Zoai:scielo:S0100-72032017001100622Revistahttp://www.scielo.br/rbgohttps://old.scielo.br/oai/scielo-oai.phppublicações@febrasgo.org.br||rbgo@fmrp.usp.br1806-93390100-7203opendoar:2017-12-21T00:00Revista brasileira de ginecologia e obstetrícia (Online) - Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO)false
dc.title.none.fl_str_mv Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
title Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
spellingShingle Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
Guida,José Paulo de Siqueira
preeclampsia
delivery
prematurity
preterm preeclampsia
title_short Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
title_full Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
title_fullStr Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
title_full_unstemmed Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
title_sort Preterm Preeclampsia and Timing of Delivery: A Systematic Literature Review
author Guida,José Paulo de Siqueira
author_facet Guida,José Paulo de Siqueira
Surita,Fernanda Garanhani
Parpinelli,Mary Angela
Costa,Maria Laura
author_role author
author2 Surita,Fernanda Garanhani
Parpinelli,Mary Angela
Costa,Maria Laura
author2_role author
author
author
dc.contributor.author.fl_str_mv Guida,José Paulo de Siqueira
Surita,Fernanda Garanhani
Parpinelli,Mary Angela
Costa,Maria Laura
dc.subject.por.fl_str_mv preeclampsia
delivery
prematurity
preterm preeclampsia
topic preeclampsia
delivery
prematurity
preterm preeclampsia
description Abstract Introduction Preeclampsia, a multifactorial disease with pathophysiology not yet fully understood, is a major cause of maternal and perinatal morbidity and mortality, especially when preterm. The diagnosis is performed when there is an association between arterial hypertension and proteinuria or evidence of severity. There are unanswered questions in the literature considering the timing of delivery once preterm preeclampsia has been diagnosed, given the risk of developingmaternal complications versus the risk of adverse perinatal outcomes associated with prematurity. The objective of this systematic review is to determine the best timing of delivery for women diagnosed with preeclampsia before 37 weeks of gestation. Methods Systematic literature review, performed in the PubMed database, using the terms preeclampsia, parturition and timing of delivery to look for studies conducted between 2014 and 2017. Studies that compared the maternal and perinatal outcomes of women who underwent immediate delivery or delayed delivery, in the absence of evidence of severe preeclampsia, were selected. Results A total of 629 studies were initially retrieved. After reading the titles, 78 were selected, and their abstracts, evaluated; 16 were then evaluated in full and, in the end, 6 studies (2 randomized clinical trials and 4 observational studies) met the inclusion criteria. The results were presented according to gestational age range (< 34 weeks and between 34 and 37 weeks) and by maternal and perinatal outcomes, according to the timing of delivery, considering immediate delivery or expectant management. Before 34 weeks, thematernal outcomeswere similar, but the perinatal outcomes were significantly worse when immediate delivery occurred. Between 34 and 37 weeks, the progression to severe maternal disease was slightly higher among women undergoing expectant management, however, with better perinatal outcomes. Conclusions When there is no evidence of severe preeclampsia or impaired fetal wellbeing, especially before 34 weeks, the pregnancy should be carefully surveilled, and the delivery, postponed, aiming at improving the perinatal outcomes. Between 34 and 37 weeks, the decision on the timing of delivery should be shared with the pregnant woman and her family, after providing information regarding the risks of adverse outcomes associated with preeclampsia and prematurity.
publishDate 2017
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dc.relation.none.fl_str_mv 10.1055/s-0037-1604103
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dc.publisher.none.fl_str_mv Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
publisher.none.fl_str_mv Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
dc.source.none.fl_str_mv Revista Brasileira de Ginecologia e Obstetrícia v.39 n.11 2017
reponame:Revista brasileira de ginecologia e obstetrícia (Online)
instname:Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO)
instacron:FEBRASGO
instname_str Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO)
instacron_str FEBRASGO
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reponame_str Revista brasileira de ginecologia e obstetrícia (Online)
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repository.name.fl_str_mv Revista brasileira de ginecologia e obstetrícia (Online) - Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO)
repository.mail.fl_str_mv publicações@febrasgo.org.br||rbgo@fmrp.usp.br
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