Biomedical subjects

S A Friedman

Publications and source records attributed to S A Friedman.

At least 37 records · Page 2Linked to original sources

PubMed1996

Serial amniotic fluid index in severe preeclampsia: a poor predictor of adverse outcome.

OBJECTIVE: The purpose of the study was to determine the relationship between low amniotic fluid index and intrauterine growth restriction and nonreassuring fetal testing in patients with severe preeclampsia. STUDY DESIGN: We reviewed the medical records of 136 women with severe preeclampsia managed conservatively for at least 48 hours. Patients were followed up with a daily nonstress test and amniotic fluid index. We evaluated amniotic fluid index < or = 5 cm and < or = 7 cm, measured on admission or just before delivery (i.e., final), and attempted to correlate these findings with the incidence of nonreassuring fetal testing necessitating cesarean section or the incidence of intrauterine growth restriction (birth weight < or = 10th percentile). RESULTS: One hundred seven patients had a cesarean section, but only 42 (39%) of these were for a nonreassuring fetal heart rate tracing or a persistent biophysical profile of < or = 4, and 38 (36%) of the pregnancies resulted in infants with intrauterine growth restriction. During expectant management, the amniotic fluid index worsened for 61 (45%) patients and improved or remained the same for 75 (55%). For those with an amniotic fluid index of < or = 5 cm both on admission and at delivery, there was a significantly higher incidence of intrauterine growth restriction compared with those with an amniotic fluid index > 5 cm (p = 0.007 and p = 0.029, respectively). However, there was no association between intrauterine growth restriction and an amniotic fluid index < or = 7 cm. Moreover, there was no difference in the frequency of nonreassuring fetal heart rate testing on the basis of amniotic fluid volume (p = 0.59) or intrauterine growth restriction (p = 0.4). CONCLUSIONS: For women with severe preeclampsia remote from term, an amniotic fluid index < or = 5 cm is predictive of intrauterine growth restriction but lacks sensitivity. There is no association between the amniotic fluid index status and frequency of cesarean section for fetal distress or nonreassuring fetal testing.

Adult↗

PubMed1996

Dietary consumption and plasma concentrations of vitamin E in pregnancies complicated by preeclampsia.

OBJECTIVE: Vitamin E, a potent antioxidant, has been suggested to play a role in preventing preeclampsia. Our aim was to determine whether consumption and plasma levels of vitamin E are lower in the preeclamptic than in normal women. STUDY DESIGN: A case-control study design was used. We identified 48 women with preeclampsia (late-pregnancy hypertension, proteinuria, and hyperuricemia). Ninety normal women served as the control group. Vitamin E consumption was estimated by use of a previously validated dietary recall questionnaire administered by a single trained research nurse to 42 of the preeclamptic women and all 90 of the control women. Blood was drawn from all women and stored until assayed at -70 degrees C. Plasma vitamin E concentrations were determined by use of high-pressure liquid chromatography. RESULTS: The mean dietary vitamin E consumption was similar for both the preeclamptic and control group (11.74 +/- 9.39 vs 11.34 +/- 7.51 mg/24 hr, p = 0.73). When the analysis also included estimations of vitamin E supplements, the total consumption was found to be higher in those who had preeclampsia than in controls (37.20 +/- 20.54 vs 22.3 +/- 27.24 mg/24 hr, p = 0.003). The mean plasma vitamin E concentration was significantly higher in preeclamptic than in control patients (1.41 +/- 0.39 vs 1.15 +/- 0.32 mg/dl, p < 0.001). Among the preeclamptic patients, those with severe disease associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (n = 11) had the highest plasma vitamin E concentrations. CONCLUSIONS: We found no evidence that low vitamin E consumption is related to the development of preeclampsia. Higher plasma vitamin E concentrations in preeclamptic patients are speculated to represent a response to oxidative stress.

Adult↗

PubMed1996

Trial of Calcium for Preeclampsia Prevention (CPEP): rationale, design, and methods.

The results of ten clinical trials suggest that supplemental calcium may prevent preeclampsia. However, methodologic problems and differences in study design limit the acceptance of the results and their relevance to other patient populations. Many of the trials were conducted in countries where, unlike the United States, the usual daily diet contained little calcium. Moreover, none of the trials has reported the outcome of systematic surveillance for urolithiasis, a potential complication of calcium supplementation. In response to the need for a thorough evaluation of the effects of calcium supplementation for the prevention of preeclampsia in the United States, the trial of Calcium for Preeclampsia Prevention (CPEP) was undertaken at five university medical centers. Healthy nulliparous patients were randomly assigned to receive either 2 g supplemental calcium daily (n = 2295) or placebo (n = 2294) in a double-blind study. Study tablets were administered beginning from 13 to 21 completed weeks of gestation and continued until the termination of pregnancy. CPEP employed detailed diagnostic criteria, standardized techniques of measurement, and systematic surveillance for the major study endpoints and for urolithiasis. The nutrient intake of each patient was assessed at randomization and at 32-33 weeks gestation. This report describes the study rationale, design, and methods.

Calcium↗

PubMed1995

Identification of the domain within fibroblast growth factor-1 responsible for heparin-dependence.

While the prototype members of the fibroblast growth factor (FGF) family, FGF-1 and FGF-2 are structurally related, the structural differences between these polypeptides predict that they will ultimately exhibit different biological roles. Indeed, a significant difference between these proteins is the dependence of FGF-1 on heparin for the generation of maximal mitogenic activity. In order to gain structural insight into the issue of FGF-1 heparin-dependence, a synthetic gene encoding FGF-2 was constructed with oligonucleotides in a four-cassette format similar to a synthetic gene previously constructed for FGF-1 (Forough et al. 1992, Biochem. Biophys. Acta 1090 293-298). This strategy permitted the molecular shuffling of corresponding cassette(s) between FGF-1 and FGF-2 to yield FGF-1:FGF-2 chimeras. Three amino acid changes (Lys86-->Glu, Tyr120-->His, and Thr121-->Ala) were introduced into the synthetic FGF-2 gene by the cassette format to generate convenient FGF-1 restriction sites, but these alterations did not significantly affect the mitogenic activity or the heparin-binding affinity of the recombinant FGF-2 protein when compared with native FGF-2. Among the various FGF-1:FGF-2 chimeric constructs, one designated FGF-C(1(1/2)1 1), which represents FGF-1 containing FGF-2 amino acid residues 65 to 81, displayed FGF-1-like heparin-binding affinity but it did not require the addition of exogenous heparin to manifest its mitogenic activity. These data suggest that the sequence within residues 65 and 81 from FGF-2 significantly contributes to the heparin-dependent character of FGF-1.

Amino Acid Sequence↗

PubMed1995

Plasma from preeclamptic women increases human endothelial cell prostacyclin production without changes in cellular enzyme activity or mass.

OBJECTIVE: We investigated differences in prostacyclin production by endothelial cells exposed to plasma from either preeclamptic women or normal pregnant women. STUDY DESIGN: A case-control study of matched preeclamptic and normal pregnancies was used to compare prostacyclin synthesis by human umbilical vein endothelial cells incubated with pregnancy plasma for 24 hours. Prostacyclin concentrations in conditioned media were measured by radioimmunoassay of its stable metabolite (6-keto-prostaglandin F1 alpha). Human umbilical vein endothelial cell lysates were used to determine concentrations of the enzymes cyclooxygenase and prostacyclin synthase. RESULTS: Prostacyclin production by human umbilical vein endothelial cells incubated with plasma from preeclamptic women was significantly greater than that by cells exposed to normal pregnancy plasma. Differences in prostacyclin production under the two experimental conditions could be explained neither by differences in enzyme mass nor activities of cyclooxygenase and prostacyclin synthase. CONCLUSION: The stimulatory effect of preeclampsia plasma on prostacyclin biosynthesis in human umbilical vein endothelial cells appears to be manifested at a step(s) proximal to the activation of cyclooxygenase. Possible mechanisms are increased phospholipase A2, lipoprotein, or lipid peroxide activities in preeclampsia.

Case-Control Studies↗

PubMed1995

Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis.

OBJECTIVE: Our purpose was to describe subsequent pregnancy outcome and long-term maternal prognosis in women with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) during the index pregnancy. STUDY DESIGN: This is a descriptive and analytic study of women with HELLP syndrome admitted to E.H. Crump Women's Hospital between August 1977 and July 1992. HELLP syndrome was defined by previously published laboratory criteria. Only patients who were delivered > 2 years ago were included (median 4 years, range 2 to 14 years). Data on these patients were obtained from our obstetric clinics, local physicians, local health departments, and hospital records. RESULTS: Adequate follow-up data were available on 341 patients. One hundred fifty-two women subsequently became pregnant. One hundred thirty-nine normotensive women had 192 subsequent pregnancies. Complications included preeclampsia (19%), preterm delivery (21%), intrauterine growth restriction (12%), abruptio placentae (2%), perinatal death (4%), and HELLP syndrome (3%). Seven of the 113 women with at least 5 years' follow-up (6.2%) had chronic hypertension, and 98 received oral contraceptive pills without complications. Thirteen women with preexisting chronic hypertension had 20 subsequent pregnancies. These women had a higher rate of preeclampsia (75%), preterm delivery (80%), intrauterine growth restriction (45%), abruptio placentae (20%), and perinatal death (40%) but a low rate of recurrent HELLP syndrome (5%). CONCLUSIONS: Women with HELLP syndrome have an increased risk of obstetric complications in future pregnancies but a low risk for recurrent HELLP syndrome. Oral contraceptive pills should not be contraindicated in normotensive women.

Adult↗

PubMed1995

Biochemical corroboration of endothelial involvement in severe preeclampsia.

This prospective, nested, case-control study investigated whether elevated plasma cellular fibronectin concentrations previously reported in preeclamptic women likely reflect endothelial dysfunction. In addition to higher maternal plasma concentrations of cellular fibronectin, we found higher levels of von Willebrand factor, tissue plasminogen activator, and plasminogen activator inhibitor-1 in maternal plasma, providing biochemical corroboration of endothelial dysfunction in severe preeclampsia.

Case-Control Studies↗

PubMed1995

Plasma and placental calcitonin gene-related peptide in pregnancies complicated by severe preeclampsia.

OBJECTIVE: Our purpose was to determine the concentration of calcitonin gene-related peptide, a potent vasodilator, in maternal plasma, fetal plasma, and placental tissue from pregnancies complicated by severe preeclampsia. STUDY DESIGN: The following groups were studied: severe preeclampsia (group 1, n = 21), normal pregnancies matched for mode of delivery (group 2, n = 21), and nonpregnant women (group 3, n = 17). Maternal venous blood samples were drawn before labor, and fetal venous samples were drawn from the chorionic plate immediately after delivery. Calcitonin gene-related peptide was also quantified in placental tissue samples from 15 patients in group 1 and 15 patients in group 2. Calcitonin gene-related peptide was measured with a sensitive and specific radioimmunoassay. RESULTS: No differences were found between maternal plasma calcitonin gene-related peptide concentrations in groups 1 and 2 (29.8 +/- 4.2 and 30.4 +/- 4.3 pmol/L, respectively). Both had levels similar to those in group 3 (28.5 +/- 5.4 pmol/L). Maternal plasma concentrations in the preeclamptic group were unchanged 3 days post partum (29.1 +/- 3.6 pmol/L). Fetal plasma calcitonin gene-related peptide concentrations were similar in groups 1 and 2 (30.2 +/- 3.9 and 32.2 +/- 8.8 pmol/L, respectively). A significant correlation was found between maternal and fetal calcitonin gene-related peptide concentrations (r = 0.43, p < 0.01). Like plasma levels, calcitonin gene-related peptide levels in the supernatants of placental extracts were not different in preeclamptic and normal pregnancies (108.0 +/- 70.4 and 100.9 +/- 56.1 fmol/gm, respectively). CONCLUSION: On the basis of plasma and placental concentrations, calcitonin gene-related peptide does not seem to play an important role in the pathophysiologic mechanisms of preeclampsia.

Biomarkers↗

PubMed1995

Daily antenatal testing in women with severe preeclampsia.

OBJECTIVE: Our purpose was to determine whether daily antenatal testing in the expectant management of severe preeclampsia remote from term prevents stillbirth or neonatal compromise at birth. STUDY DESIGN: We reviewed the medical records of 68 women with severe preeclampsia remote from term who underwent expectant management with daily fetal testing until delivery. On admission each patient had reassuring nonstress testing (absence of persistent severe variable or late decelerations), biophysical profile (> or = 6), and amniotic fluid volume (> or = 2 cm maximal vertical pocket before 32 weeks or amniotic fluid index > or = 5 after 32 weeks). RESULTS: There were no stillbirths. Twenty-one patients (31%) had nonreassuring testing necessitating delivery. Two neonatal deaths occurred as a result of complications of prematurity. There were no statistical differences in the cord arterial pH (p = 0.93) or in the 1- and 5-minute Apgar scores (p = 0.18 and p = 0.88, respectively) between those with normal and abnormal antenatal testing. CONCLUSIONS: Because optimizing neonatal outcome is the only reason to prolong pregnancy in women with severe preeclampsia, confirmation of fetal well-being is mandatory. Because neither stillbirths nor fetal compromise at birth occurred in patients undergoing daily antenatal testing, we recommend daily testing in patients with severe preeclampsia managed expectantly.

Adolescent↗

PubMed1995

Neonatal outcome after preterm delivery for preeclampsia.

OBJECTIVE: Our purpose was to determine whether maternal preeclampsia per se has a beneficial effect on neonatal outcome after delivery before 35 weeks. STUDY DESIGN: A matched cohort study design was used. Two hundred twenty-three infants of strictly defined preeclamptic women were matched for gestational age, race, gender, and mode of delivery with infants of normotensive women with preterm labor and delivery. Pregnancies with multiple gestation, premature rupture of membranes, known fetal anomalies, diabetes, or maternal medical disease were excluded. Information was obtained by review of maternal and neonatal charts. Paired categoric and continuous data were compared by McNemar's test and the Wilcoxon signed-rank test, respectively. RESULTS: There was no difference in the incidence of neonatal death (4.5% vs 4.5%, p = 0.82), respiratory distress syndrome (22.0% vs 22.0%, p = 0.88), grades 3 and 4 intraventricular hemorrhage (2.2% vs 2.2%, p = 0.72), grades 2 and 3 necrotizing enterocolitis (5.8% vs 4.0%, p = 0.48), and culture-proved sepsis (9.0% vs 9.0%, p = 0.85). Results were similar when analysis was limited to infants born at < or = 32 weeks, infants born to mothers with severe preeclampsia, and infants with intrauterine growth restriction. CONCLUSION: Maternal preeclampsia per se does not have a beneficial effect on the postnatal course of infants born at 24 to 35 weeks' gestation.

Betamethasone↗

PubMed1995

Preeclampsia and related disorders. Clinical aspects and relevance of endothelin and nitric oxide.

Preeclampsia is a pregnancy-specific disorder believed to result from widespread endothelial dysfunction. Endothelin and NO are two potent vasoactive agents of endothelial origin and, as such, are postulated to play an important role in the pathogenesis of preeclampsia. If these agents are found to be important in preeclampsia, they will most likely exert their effects locally, rather than systemically. Future research on the autocrine and paracrine effects of endothelin and NO may yield important insights into the cause and pathogenesis of this enigmatic disease.

Animals↗

PubMed1994

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

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.

Adolescent↗

PubMed1994

Tumor necrosis factor-alpha in pregnancies associated with preeclampsia or small-for-gestational-age newborns.

OBJECTIVE: Our purpose was to determine the presence and concentration of tumor necrosis factor-alpha in maternal and fetal plasma in pregnancies associated with preeclampsia and small-for-gestational-age newborns. STUDY DESIGN: Maternal and fetal plasma tumor necrosis factor-alpha concentrations were measured in nonpregnant women (n = 12), women with normal pregnancies (n = 24), and women with pregnancies associated with severe preeclampsia (n = 23), small-for-gestational-age newborns newborns (n = 14), or both preeclampsia and small-for-gestational-age newborns (n = 12). Tumor necrosis factor-alpha was measured with a sensitive and specific enzyme immunoassay. RESULTS: Tumor necrosis factor-alpha was detected in 89% of the samples studied. Concentrations ranged from < 1.5 to 30 pg/ml. Similar levels were found in women with severe preeclampsia with or without small-for-gestational-age newborns, women who were delivered vaginally or abdominally in the control group, and nonpregnant women. Maternal and fetal tumor necrosis factor-alpha in the group with idiopathic small-for-gestational-age newborns were in general lower than those of all other groups. The route of delivery did not affect tumor necrosis factor-alpha concentrations in both the maternal and fetal plasma. There was a significant correlation between fetal venous and arterial plasma concentrations (r = 0.51, p = 0.01). CONCLUSIONS: Our study is the first to demonstrate a decrease in maternal and fetal plasma concentrations of tumor necrosis factor-alpha in pregnancies associated with idiopathic small-for-gestational-age newborns. This reduction may have endocrinologic importance or may reflect widespread paracrine and autocrine events. On the other hand, our findings do not support a fundamental endocrine role of tumor necrosis factor-alpha in preeclampsia.

Case-Control Studies↗

PubMed1994

Plasma cellular fibronectin as a measure of endothelial involvement in preeclampsia and intrauterine growth retardation.

OBJECTIVE: Our purpose was to determine the presence and degree of endothelial injury, by measuring plasma concentrations of cellular fibronectin, in pregnancies complicated by preeclampsia or intrauterine growth retardation. STUDY DESIGN: A matched, nested, case-control study design was used. Plasma was collected prospectively from pregnant women throughout gestation. At least 12 weeks after delivery women with preeclampsia, both preeclampsia and intrauterine growth retardation, or intrauterine growth retardation alone were identified. Normal controls were matched to these patients by age, race, and gestational age. Stored plasma, which had been obtained in the third trimester, was assayed for cellular fibronectin by means of a sensitive and specific enzyme immunoassay. After an appropriate transformation of the data results were compared with one-way analysis of variance with Fisher's post hoc test. RESULTS: Patients with preeclampsia (n = 18) had higher plasma cellular fibronectin concentrations than did control patients (n = 68) with median values of 2.8 and 1.4 micrograms/ml, respectively (p < 0.001, using transformed data). Patients with intrauterine growth retardation alone (n = 10) had 2.3 micrograms/ml cellular fibronectin, significantly higher than values of controls (p < 0.02 using transformed data) and significantly lower than those of patients with preeclampsia (p < 0.05 using transformed data). CONCLUSION: Pregnancies complicated by preeclampsia had significantly higher plasma cellular fibronectin concentrations than did pregnancies with intrauterine growth retardation alone, which in turn had significantly higher plasma cellular fibronectin concentrations than did control pregnancies. We speculate that endothelial involvement in intrauterine growth retardation is confined to the uteroplacental circulation, whereas it is systemic in preeclampsia.

Adult↗

PubMed1994

Urinary dipstick protein: a poor predictor of absent or severe proteinuria.

OBJECTIVE: Our purpose was to compare urinary protein dipstick values with standard 24-hour urinary protein excretion in women with hypertension in pregnancy. STUDY DESIGN: Urinary protein dipstick determinations and concurrent 24-hour urinary protein excretion measurements were compared by review of 300 urine samples obtained from women with hypertension in pregnancy. RESULTS: One hundred twenty-three samples had negative to trace protein on dipstick on two occasions at least 6 hours apart. Eight-one (66%) of these patients had significant proteinuria (> or = 300 mg per 24 hours). Seventy-six samples revealed 3+ to 4+ protein on dipstick in at least two samples. Of these, 27 (36%) had heavy proteinuria (> or = 5 gm per 24 hours), and 42 (55%) had nephrotic range proteinuria of > or = 3.5 gm per 24 hours. One hundred one patients had urine dipstick values of 1+ to 2+, of whom 89 (88%) had significant proteinuria. CONCLUSION: Urinary protein dipstick values > or = 1+ have a positive predictive value of 92% (162/177) for predicting > or = 300 mg per 24 hours. In contrast, a dipstick of negative to trace should not be used to rule out significant proteinuria because its negative predictive value is only 34% (42/123) in hypertensive patients. Moreover, urine dipstick values of 3+ to 4+ should not be used to diagnose severe preeclampsia because their positive predictive value is only 36% (27/76).

Adult↗

PubMed1994

Late postpartum eclampsia revisited.

OBJECTIVE: To describe the clinical and neurologic findings in patients with late postpartum eclampsia (convulsions beginning more than 48 hours, but less than 4 weeks, after delivery). METHODS: This study evaluated all patients with the diagnosis of late postpartum eclampsia managed at our institution between August 1977 and July 1992. RESULTS: There were 54 cases of late postpartum eclampsia among a total of 334 cases of eclampsia during the study period. Late postpartum eclampsia constituted 56% of total postpartum eclampsia and 16% of all cases of eclampsia. Convulsions began from postpartum days 3-23 (mean 6). Thirty women (56%) had been identified as preeclamptic before their convulsions. A history of either severe headache or visual disturbances before convulsion was elicited in 83% of the patients. During the study period, eight women not included in the study group had late postpartum seizures attributed to other causes. CONCLUSIONS: Severe headache or visual disturbance frequently antedates late postpartum eclampsia. Only eight of 62 patients with late postpartum seizures had identifiable etiologies other than eclampsia.

Adult↗

PubMed1994

Obstetric characteristics among nulliparas under age 15.

OBJECTIVE: To describe and analyze the obstetric characteristics of adolescent women under 15 years of age. METHODS: A matched cohort design was used. The pregnancies of 261 nulliparous women under age 15 delivered at our institution between January 1990 and December 1992 were compared to 261 nulliparous controls aged 20-29, matched for race, infant gender, and year of delivery. Multiple gestation and delivery immediately after hospital admission were exclusion criteria. RESULTS: The number of antepartum admissions was identical (n = 35 in each group). There were no significant differences between the study and control groups in cervical dilatation at admission, frequency of labor induction (12.6% for each), epidural anesthesia (44.4 versus 49.4%), mean birth weight (2918 +/- 661 versus 2979 +/- 753 g), or preterm birth (24.1 versus 20.3%). Use of oxytocin was less common and magnesium sulfate more common in the adolescent group. Nevertheless, the duration of the active phase of labor and the rate of cesarean delivery were significantly lower in the adolescent group (4.5 +/- 2.7 versus 5.2 +/- 2.4 hours, P = .02; and 13.8 versus 25.3%, P = .001, respectively). The incidence of operative vaginal delivery was not different between the groups. Analysis of the data after controlling for fetal presentation, marital status, and insurance status did not alter these findings. Postpartum complications were similar. CONCLUSION: Pregnancy at the lower limit of reproductive age in an urban American population is not associated with an abnormal labor course, as is commonly believed.

Adolescent↗

PubMed1994

Conservative management of severe preeclampsia remote from term.

Traditionally, preeclamptic women who meet established criteria for severe disease are delivered expeditiously. Although delivery is always appropriate therapy for the mother, it may not be for the fetus remote from term. Two recent randomized clinical trials have demonstrated favorable neonatal outcomes after conservative management of severe preeclampsia remote from term. Nevertheless, because such management entails risk for both the mother and fetus, patients must be selected carefully. We consider women who have severe disease--by ACOG criteria for blood pressure (systolic persistently at least 160 mmHg or diastolic persistently at least 110 mmHg) or proteinuria (5 g/day or greater)--to be candidates for conservative management with close maternal and fetal surveillance. As long as maternal blood pressure can be controlled pharmacologically, maternal laboratory values are stable, and fetal biophysical profiles are normal, we manage these patients conservatively up to 34 weeks' gestation. Using these guidelines at our institution, we found that approximately two-thirds of patients with severe preeclampsia before 34 weeks were eligible for conservative management. We recommend that such management be performed only at tertiary perinatal centers.

Clinical Protocols↗