Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Expectant or outpatient management of preeclampsia before 34 weeks: safe for mother but associated with increased stillbirth risk

Journal of Human Hypertension volume 33, pages 664–670 (2019)Cite this article

Subjects

Abstract

Today the only effective “treatment” for preeclampsia is to deliver at the optimal time for both maternal and foetal well-being. Studies reported that severe preeclampsia can benefit from the expectant management including mild preeclampsia between 34 and 37 weeks. However it is unclear whether mild preeclampsia before 34 weeks also benefits from the expectant management. Data on 274 women with mild preeclampsia before 37 weeks of gestation were retrospectively collected and analysed. Blood pressure and proteinuria at time of onset were not clinically associated with delivery time. For women who developed preeclampsia before 34 weeks, the median latency from onset to delivery or from onset to admission to hospital or from admission to hospital to delivery was 27 or 21 or 3 days, respectively. There were four women (2%) who delivered within 48 h after onset, 28 (14%) FGR and 14 (7%) stillbirths. The median birth-weight was 2240 g. For women who developed preeclampsia between 34 and 37 weeks, the median latency from onset to delivery or from onset to admission to hospital or from admission to hospital to delivery was 11 or 7 or 2 days, respectively. There were seven women (10%) who delivered within 48 h after onset and eight (12%) FGR. The median birth-weight was 2880 g. Our study demonstrates that mild preeclampsia before 37 weeks has benefits from expectant or outpatient management with a median prolongation of over 11 days dependent on the time of onset, but it increases the risk for stillbirths before 34 weeks.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183:S1–22.

  2. Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertens. 2014;4:97–104.

    Article  CAS  Google Scholar 

  3. Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365:785–99.

    Article  Google Scholar 

  4. Cnossen JS, Morris RK, ter Riet G, Mol BWJ, van der Post JAM, Coomarasamy AZ, et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. Can Med Assoc J. 2008;178:701–11.

    Article  Google Scholar 

  5. Powers RW, Jeyabalan A, Clifton RG, Van Dorsten P, Hauth JC, Klebanoff MA, et al. Soluble fms-Like Tyrosine Kinase 1 (sFlt1), Endoglin and Placental Growth Factor (PlGF) in Preeclampsia among High Risk Pregnancies. Plos ONE. 2010;5:13263–75.

  6. Xiao J, Shen F, Xue Q, Chen G, Zeng K, Stone P, et al. Is ethnicity a risk factor for developing preeclampsia? An analysis of the prevalence of preeclampsia in China. J Hum Hypertens. 2014;28:694–8.

    Article  CAS  Google Scholar 

  7. Dong X, Gou W, Li C, Wu M, Han Z, Li X, et al. Proteinuria in preeclampsia: not essential to diagnosis but related to disease severity and fetal outcomes. Pregnancy Hypertens. 2017;8:60–4.

    Article  Google Scholar 

  8. Belghiti J, Kayem G, Tsatsaris V, Goffinet F, Sibai BM, Haddad B. Benefits and risks of expectant management of severe preeclampsia at less than 26 weeks gestation: the impact of gestational age and severe fetal growth restriction. Am J Obstet Gynecol. 2011;205:465 e1–6.

    Article  Google Scholar 

  9. Bombrys AE, Barton JR, Habli M, Sibai BM. Expectant management of severe preeclampsia at 27(0/7) to 33(6/7) weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management. Am J Perinatol. 2009;26:441–6.

    Article  Google Scholar 

  10. Bombrys AE, Barton JR, Nowacki EA, Habli M, Pinder L, How H, et al. Expectant management of severe preeclampsia at less than 27 weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management. Am J Obstet Gynecol. 2008;199:247 e1–6.

    Article  Google Scholar 

  11. Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol. 2007;196:514 e1–9.

    Article  Google Scholar 

  12. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122–31.

    Article  Google Scholar 

  13. Sibai BM. Management of late preterm and early-term pregnancies complicated by mild gestational hypertension/pre-eclampsia. Semin Perinatol. 2011;35:292–6.

    Article  Google Scholar 

  14. Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ, et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre, open-label randomised controlled trial. Lancet. 2009;374:979–88.

    Article  Google Scholar 

  15. Vigil-De Gracia P, Reyes Tejada O, Calle Miñaca A, Tellez G, Chon VY, Herrarte E, et al. Expectant management of severe preeclampsia remote from term: the MEXPRE Latin Study, a randomized, multicenter clinical trial. Am J Obstet Gynecol. 2013;209:425.e1–8.

    Article  Google Scholar 

  16. Broekhuijsen K, van Baaren G-J, van Pampus MG, Ganzevoort W, Sikkema JM, Woiski MD, et al. Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. Lancet. 2015;385:2492–501.

    Article  Google Scholar 

  17. Hypertension in Pregnancy. American College of Obstetricians and Gynecologists Women's Health Care Physician. Obstetrics & Gynecology, 2013;122:1122–31.

  18. van der Tuuk K, Koopmans CM, Groen H, Aarnoudse JG, van den Berg PP, van Beek JJ, et al. Prediction of progression to a high risk situation in women with gestational hypertension or mild pre-eclampsia at term. Aust N Z J Obstet Gynaecol. 2011;51:339–46.

    Article  Google Scholar 

  19. Lindheimer MD, Kanter D. Interpreting abnormal proteinuria in pregnancy: the need for a more pathophysiological approach. Obstet Gynecol. 2010;115(2 Pt 1):365–75.

    Article  CAS  Google Scholar 

  20. James PR, Nelson-Piercy C. Management of hypertension before, during, and after pregnancy. Heart. 2004;90:1499–504.

    Article  Google Scholar 

  21. Magee LA, Ornstein MP, von Dadelszen P. Fortnightly review: management of hypertension in pregnancy. BMJ. 1999;318:1332–6.

    Article  CAS  Google Scholar 

  22. Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive Versus Expectant Management of Severe Preeclampsia at 28 to 32 Weeks Gestation - a Randomized Controlled Trial. Am J Obstet Gynecol. 1994;171:818–22.

    Article  CAS  Google Scholar 

  23. Odendaal HJ, Pattinson RC, Bam R, Grove D, Kotze TJV. Aggressive or Expectant Management for Patients with Severe Preeclampsia between 28-34 Weeks Gestation - a Randomized Controlled Trial. Obstet Gynecol. 1990;76:1070–5.

    CAS  PubMed  Google Scholar 

  24. Valent AM, DeFranco EA, Sibai BM. Expectant management of mild preeclampsia REPLY. Am J Obstet Gynecol. 2015;213:750–1.

    Article  Google Scholar 

Download references

Acknowledgements

This study was received the support from Shanxi Province Science and Technology Development project, China (Grant number 2015SF124) and Shanxi Province International collaborative program (Grant number 2016KW-006).

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynaecology, First affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Jing Fu, Chunfang Li, Wenli Gou & Xuelan Li

  2. Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand

    Arier Lee

  3. The Hospital of Obstetrics & Gynaecology, Fudan University, Shanghai, China

    Qi Chen

  4. Department of Obstetrics & Gynaecology, The University of Auckland, Auckland, New Zealand

    Qi Chen

Authors
  1. Jing Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chunfang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wenli Gou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arier Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xuelan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Xuelan Li or Qi Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fu, J., Li, C., Gou, W. et al. Expectant or outpatient management of preeclampsia before 34 weeks: safe for mother but associated with increased stillbirth risk. J Hum Hypertens 33, 664–670 (2019). https://doi.org/10.1038/s41371-019-0175-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-019-0175-1

Search

Advanced search

Quick links