Lam - Hip - Expectant Mgmt - 2009

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Hypertension in Pregnancy, 28:312347, 2009

Copyright Informa Healthcare USA, Inc.

ISSN: 1064-1955 print / 1525-6065 online

DOI: 10.1080/10641950802601252

LHIP1064-19551525-6065Hypertensionin Pregnancy,Vol.1,No.1, December 2008: pp. 161Hypertensionin Pregnancy

Expectant Managementof Severe PreeclampsiaRemote from Term:A Structured SystematicReviewEarly Care of Expectant PreeclampsiaMagee et al.

L.A. Magee,1,2,3,4P.J. Yong,2V. Espinosa,4A.M. Ct,1

I. Chen,2and P. von Dadelszen2,3,4

1Departments of Medicine, University of British Columbia, Vancouver, BC, V6H 3N1,Canada2Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, V6H3N1, Canada3Population and Public Health, University of British Columbia, Vancouver, BC, V6H3N1, Canada4CFRI Centre for Applied Health Research and Evaluation, University of BritishColumbia, Vancouver, BC, V6H 3N1, Canada

Objective: To compare outcomes associated with expectant vs. interventionist care of

severe preeclampsia in observational studies. Data Sources: Medline (01/198007/

2007), bibliographies of retrieved papers, personal files, Cochrane Database of

Systematic Reviews. Study Selection: Expectant or interventionist care of preeclampsia

at


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Early Care of Expectant Preeclampsia 313

preeclampsia or HELLP


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314 Magee et al.

expectant care of severe preeclampsia remote from term, and compare these

with the published observational experience with a policy of interventionist care.

METHODS

We searched OVID Medline (01/01/1980 to 13/07/2007), with the assistance of a

librarian (Tricia Yu, Eric Hamber Library, BC Womens Hospital, Vancouver)

and using the following keywords: {pregnancy, pregnancy complications,

pregnancy trimesters, pregnancy, or multiple} AND {preeclampsia, preec-

lampsia, pregnancy toxemias, or hypertension} AND {early intervention, early

delivery, interventionist, aggressive, active management, delayed interven-tion, delayed delivery, conservative management, expectant management,

temporizing management, temporising management, temporizing treatment,

or temporising treatment}. The following were also reviewed for additional

studies: personal files and bibliographies of retrieved papers, reviews in the

Cochrane Database of Systematic Reviews, review articles, and guidelines.

Our inclusion criteria were: inception from 1980, women with severe

preeclampsia remote from term [


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Early Care of Expectant Preeclampsia 315

variables of study characteristics (country, design), participants (exclusion of

HELLP syndrome), and intervention (policy/protocol, a priori indications for

delivery, stabilization prior to expectant care, details of intervention, and use

of MgSO4 and/or corticosteroids) was not possible as no more than 25% of

studies provided sufficient information on variables of interest.

RESULTS

Through Medline (19802007), we identified 270 potentially relevant articles.

Figure 1 details reasons for exclusion and the addition of 28 papers from review

of the bibliographies and personal files of LM (734); these papers included

Figure 1: Consort diagram: Search strategy.

Potentially relevant citations identifiedfrom electronic search (N=270)

Citations excluded (N=101)Reasons:

RCT of aggressive vs. expectant management (N=2)

Not English/French(N=23)

Review article/editorial/letter (N=51)

Case report (N=24)Survey(N=1)

Animal study(N=1)

Citations excluded (N=125)

Reasons:Not earlypreeclampsia(N=52)

Not expectant management (N=68)

Cohort recruited before 1980 (N=5)

Studies retrieved for furtherevaluation (N=169)

Citations included from reviewof files/bibiographies (N=28)Please see text for citations.

Studies INCLUDED (N=72)


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316 Magee et al.

RCTs of antihypertensive vs. other therapy in which expectant care was applied

to women in both groups; each arm of the trial was treated as a separate cohort.

For expectant care, there were 39 cohorts (49 publications) for severe preec-

lampsia at


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Table1:Stu

diesofexpectantorinterven

tionistcareofseverepreecla

mpsiaremotefromterm.

Study

(country)

Recruitment

interval/

Design

Nwomen/T

ype

ofPET*

GAat

recruitment

(wk)

Expectan

tor

interventionist

care

(Description)

Expectant

careafter

stabilization?

Outcom

es

Notes(includingoverlapping

studies)

Banias1992

(USA)

06/198307/

1988Retro

cohort

N=67Severe

PET(includ

ed

HELLP)

2632

Expectant

(Poor)

Unclear

Materna

l

Fetal

Mostwomenweretransfe

rred

forcareafterexpectantcare

atanotherinstitution

Begum200

2

(India)

01/199810/

2000Pros

cohort

N=51Severe

PET(includ

ed

eclampsia)

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Lam - Hip - Expectant Mgmt - 2009