Expectant management of sPE at less than 27 wks

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dja
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Re : Expectant management of sPE at less than 27 wks

Postby dja » Sun Sep 06, 638308 2:52 pm

This is pretty amazing. WHen I had PE, I was told there was basically no literature on women in my situation. This study is incredibly informative and the maternal morbidity for my class (64% of those less than 24 weeks) is truly awful. Is there any potential that the results of this type of study, limited as it is, could be translated into useful information for women facing the very early onset PE? WHen they hit you with this stuff, you want so much to hope that you can just wait it out - sounds very dangerous though.

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caryn
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Expectant management of sPE at less than 27 wks

Postby caryn » Sat Sep 05, 638308 4:15 pm

Median days of prolongation was 6 (range 2-46). Overall perinatal survival was 29 of 51 (57%). Birthweights of 27 (53%) were less than 10%, and 18 (35%) were less than 5%. There were no perinatal survivors in those with a GA less than 23 weeks, at 23 to 23 6/7 weeks, 2 of 10 (20%) survived, and both reached 26 weeks at delivery. For those at 24 to 24 6/7, 25 to 25 6/7, and 26 to26 6/7 weeks, the perinatal survival rates were 5 of 7 (71%), 13 of 17 (76%), and 9 of 10 (90%), respectively; but rates of respiratory complications were high. There were no maternal deaths, but overall maternal morbidity was 21 of 46 (46%), but was 9 of 14 (64%) in those at less than 24 weeks.

http://www.ncbi.nlm.nih.gov/pubmed/18771971

So it is both difficult and dangerous to prolong severe preeclamptic pregnancies in the hope of saving the baby's life, and it doesn't work all that well. The rate of surviving babies ticks up dramatically at 24 weeks when the lungs mature enough to work with, to 71%, and the number of severe injuries to the mother (superimposed HELLP, kidney failure, seizure) is also very high if they try to push the pregnancy before 24 weeks, at 64%.

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