OS011. Management of late preterm pregnancy complicated by mildpreeclampsia: A prospective randomized trial

J N Martin Jr; M Y Owens; B Thigpen; M R Parrish; S D Keiser; K Wallace

doi:10.1016/j.preghy.2012.04.012

OS011. Management of late preterm pregnancy complicated by mildpreeclampsia: A prospective randomized trial

Pregnancy Hypertens. 2012 Jul;2(3):180. doi: 10.1016/j.preghy.2012.04.012. Epub 2012 Jun 13.

Authors

J N Martin Jr¹, M Y Owens¹, B Thigpen¹, M R Parrish¹, S D Keiser¹, K Wallace¹

Affiliation

¹ University of Mississippi Medical Center, Jackson, United States.

PMID: 26105225
DOI: 10.1016/j.preghy.2012.04.012

Abstract

Introduction: In the absence of properly undertaken prospective randomized clinical trials, the optimal management of late preterm mild preeclampsia for best maternal and perinatal outcomes remains unclear for obstetricians worldwide.

Objectives: We desired to determine if immediate or expectant management of the late preterm mother presenting with mild preeclampsia was more beneficial to her without compromise to her newborn.

Methods: This prospective randomized clinical trial of immediate versus expectant delivery for patients presenting with mild preeclampsia between the late preterm period of 34-0/7 to 36-6/7weeks gestation was undertaken using CONSORT guidelines. Patients were randomized to immediate delivery via induction of labor or cesarean delivery or inpatient expectant management with delivery at 37-0/7weeks gestation or earlier at onset of labor or progression to severe preeclampsia. The primary outcome was progression to severe preeclampsia; secondary outcomes were neonatal morbidity and mortality. Data were analyzed by appropriate tests for continuous or categorical outcomes with differences considered significant if p<0.05.

Results: One hundred and sixty nine patients during 2002-2008 satisfied and sustained protocol criteria in the immediate delivery (n=94) or inpatient expectant management (n=75) arms of the study. A third (33%) of expectantly managed patients developed severe preeclampsia during significantly longer hospitalization versus 3% in the immediately delivered patients (p=0.001). Cesarean delivery rates were similar. No significant neonatal morbidity differences were observed between groups; there were no maternal or neonatal deaths. The study was stopped in 2008 at 74% of the enrollment target when hospital policy changed to discourage inpatient hospitalization for uncomplicated mild preterm preeclampsia and in view of growing national concern for increased late preterm/early term neonatal morbidity and cost of care.

Conclusion: Proceeding to delivery of the late preterm (⩾34weeks gestation) patient with mild preeclampsia lessens maternal risk without significantly increasing neonatal risk.