Manejo expectante versus manejo agresivo en la preeclampsia severa lejos del termino - Expectant versus interventionist care for the management of severe preeclampsia remote from term

Objective: To assess the safety and effectiveness of expectant care for the management of severe preeclampsia remote from term. Materials y methods: Randomized controlled clinical trials and non clinical trials with control group, that compare expectant versus interventionist care for the management of severe preeclampsia between 24 to 34 gestation weeks. Expectant management was defined as glucocorticoid therapy followed by delivery only for specific maternal/fetal indications or reaching 34 weeks of gestation. Interventionist care was defined as induction of delivery from 24 to 48 hours after complete fetal pulmonary maturation with corticosteroids. Results: It included 10 trials had a total of 885 participants. Four studies were randomized controlled clinical trials and six non-randomized controlled studies. Gestational age at entry was 28.5 to 31.5 weeks in rank or aggressive management and 29.2 to 31.1 weeks for expectant management. Nulliparous women were majority in 6 studies from 50 to 96.4% in both groups. Evidence from clinical trials suggested that in interventionist care group there were smaller for gestational age babies compared with babies who received expectant care (RR 2.68, 95% CI 1.67 to 4.3). The median deviation of pregnancy prolongation was 7.46 [6.01, 8.91] days. On the other hand, non-randomized controlled studies showed a relative risk reduction of 76% (RR 0.24, 95%CI 0.09 to 0.68) for eclampsia, and of 58% (RR 0.42, 95%CI 0.22 to 0.80) for stillbirth in expectant group. Overall there are not significative difference between managements in maternal death, HELLP syndrome, placental abruption, caesarean section, pulmonary edema, renal failure, neonatal death, intraventricular hemorrhage, low apgar score 7 at 5 minute, hyaline membrane disease, and NICU admission.

• Autores: Quintero Ortíz, María Andrea
• Tipo de recurso: Trabajo de grado de pregrado
• Fecha de publicación: 2018
• Institución: Universidad Nacional de Colombia
• Repositorio: Universidad Nacional de Colombia
• Idioma: spa
• OAI Identifier: oai:repositorio.unal.edu.co:unal/69343
• Acceso en línea: https://repositorio.unal.edu.co/handle/unal/69343; http://bdigital.unal.edu.co/71047/
• Palabra clave: 61 Ciencias médicas; Medicina / Medicine and health; Severe preeclampsia; Expectant management; Interventionist care; Preeclampsia severa; Manejo expectante; Manejo agresivo
• Rights: openAccess
• License: Atribución-NoComercial 4.0 Internacional