Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia | 2021
Expectant Versus Interventionist Care in the Management of Severe Preeclampsia Remote from Term: A Systematic Review.
Abstract
OBJECTIVE\n\u2003To compare the effects of expectant versus interventionist care in the management of pregnant women with severe preeclampsia remote from term.\n\n\nDATA SOURCES\n\u2003An electronic search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILACS, for its Spanish acronym), World Health Organization s International Clinical Trials Registry Platform (WHO-ICTRP), and OpenGrey databases. The International Federation of Gynecology and Obstetrics (FIGO, for its French acronym), Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and Colombian Journal of Obstetrics and Gynecology (CJOG) websites were searched for conference proceedings, without language restrictions, up to March 25, 2020.\n\n\nSELECTION OF STUDIES\n\u2003Randomized clinical trials (RCTs), and non-randomized controlled studies (NRSs) were included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of the evidence.\n\n\nDATA COLLECTION\n\u2003Studies were independently assessed for inclusion criteria, data extraction, and risk of bias. Disagreements were resolved by consensus.\n\n\nDATA SYNTHESIS\n\u2003Four RCTs and six NRS were included. Low-quality evidence from the RCTs showed that expectant care may result in a lower incidence of appearance, pulse, grimace, activity, and respiration (Apgar) scores\u2009<\u20097 at 5\u2009minutes (risk ratio [RR]: 0.48; 95% confidence interval [95%CI]: 0.23%to 0.99) and a higher average birth weight (mean difference [MD]: 254.7\u2009g; 95%CI: 98.5\u2009g to 410.9\u2009g). Very low quality evidence from the NRSs suggested that expectant care might decrease the rates of neonatal death (RR: 0.42; 95%CI 0.22 to 0.80), hyaline membrane disease (RR: 0.59; 95%CI: 0.40 to 0.87), and admission to neonatal care (RR: 0.73; 95%CI: 0.54 to 0.99). No maternal or fetal differences were found for other perinatal outcomes.\n\n\nCONCLUSION\n\u2003Compared with interventionist management, expectant care may improve neonatal outcomes without increasing maternal morbidity and mortality.