Tratamiento intervencionista versus expectante para la preeclampsia grave entre las semanas 24 y 34 de embarazo
Información
- DOI:
- https://doi.org/10.1002/14651858.CD003106.pub2Copiar DOI
- Base de datos:
-
- Cochrane Database of Systematic Reviews
- Versión publicada:
-
- 26 julio 2013see what's new
- Tipo:
-
- Intervention
- Etapa:
-
- Review
- Grupo Editorial Cochrane:
-
Grupo Cochrane de Embarazo y parto
- Copyright:
-
- Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
Altmetric:
Citado por:
Autores
Contributions of authors
Lelia Duley and David Churchill contributed to the development of the protocol. Both authors assessed potentially eligible studies for inclusion in the first version of this review, and extracted data. D Churchill entered data, and these were checked by L Duley. Both authors contributed to writing the review.
For the 2013 update, Leanne Jones updated the methods and assessed studies for inclusion, extracted data, entered data, and these were checked by David Churchill. Leanne Jones wrote the first draft of the updated results. David Churchill, Lelia Duley and Jim Thornton commented on all drafts of the 2013 update and made edits.
Sources of support
Internal sources
-
No sources of support supplied
External sources
-
National Institute for Health Research, UK.
UK NIHR Programme of centrally‐managed pregnancy and childbirth systematic reviews of priority to the NHS and users of the NHS: 10/4001/02
Declarations of interest
Jim Thornton is an author on one of the included studies (GRIT 2003). However, he was not involved in any assessment, data extraction or data analysis of this trial.
Acknowledgements
As part of the pre‐publication editorial process, this review has been commented on by three peers (an editor and two referees who are external to the editorial team) and the Group's Statistical Adviser.
The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pregnancy and Childbirth Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2018 Oct 05 | Interventionist versus expectant care for severe pre‐eclampsia between 24 and 34 weeks' gestation | Review | David Churchill, Lelia Duley, Jim G Thornton, Mahmoud Moussa, Hind SM Ali, Kate F Walker | |
| 2013 Jul 26 | Interventionist versus expectant care for severe pre‐eclampsia between 24 and 34 weeks' gestation | Review | David Churchill, Lelia Duley, Jim G Thornton, Leanne Jones | |
| 2002 Jul 22 | Interventionist versus expectant care for severe pre‐eclampsia before term | Review | David Churchill, Lelia Duley | |
Differences between protocol and review
In 2013, the methods were updated. The inclusion criteria were modified to define more clearly the criteria for types of participants:
Women with severe pre‐eclampsia before or equal to 34 weeks' gestation. Severe pre‐eclampsia was defined as high blood pressure, > 140/90 mmHg on two consecutive occasions four or more hours apart and proteinuria greater than 300 mg/24 hours. Alternatively as:
-
severe hypertension (blood pressure at least 160 mmHg systolic, or 110 mmHg diastolic) alone;
or hypertension as defined above plus one or more of the following criteria:
-
severe proteinuria (usually at least 3 g (range 2 g to 5 g) protein in 24 hours, or 3+ on dipstick);
-
reduced urinary volume (less than 500 mL in 24 hours), upper abdominal pain, pulmonary oedema;
-
neurological disturbances (such as headache, visual disturbances, and exaggerated tendon reflexes);
-
impaired liver function tests, high serum creatinine, low platelets;
-
suspected intrauterine growth restriction or reduced liquor volume.
This latter set of criteria reflect the natural history of the disease and clinical practice when diagnosing severe pre‐eclampsia.
Primary and secondary outcomes were defined.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Cerebral Hemorrhage [epidemiology];
- Cesarean Section [statistics & numerical data];
- *Delivery, Obstetric [adverse effects, methods];
- Eclampsia [epidemiology];
- Enterocolitis, Necrotizing [etiology];
- HELLP Syndrome [epidemiology];
- Hyaline Membrane Disease [etiology];
- Perinatal Mortality;
- Pre-Eclampsia [*therapy];
- Pulmonary Edema [epidemiology];
- Randomized Controlled Trials as Topic;
- *Watchful Waiting;
Medical Subject Headings Check Words
Female; Humans; Infant, Newborn; Pregnancy;
PICO
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 1 Eclampsia.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 2 HELLP syndrome.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 3 Pulmonary oedema.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 4 Death of the baby (all stillbirths, neonatal and infant deaths).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 5 Death of the baby (subgrouped by time of death).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 6 Intraventricular haemorrhage or hypoxic ischaemic encephalopathy.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 7 Renal failure.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 8 Caesarean section.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 9 Placental abruption.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 10 Low Apgar score at five minutes (< 7 at five minutes).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 11 Neonatal seizures.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 12 Hyaline membrane disease.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 13 Necrotising enterocolitis.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 14 Baby ventilated.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 15 Measures of long‐term growth & development (cerebral palsy).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 16 Measures of long‐term growth & development (poor hearing/hearing aid).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 17 Measures of long‐term growth & development (impaired vision).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 18 Small‐for‐gestational age.
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 19 Gestation at birth (days).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 20 Length of stay in neonatal intensive care unit (days).
Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 21 Admission to neonatal intensive care unit.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Eclampsia Show forest plot | 1 | 95 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 2 HELLP syndrome Show forest plot | 1 | 95 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.53 [0.05, 5.68] |
| 3 Pulmonary oedema Show forest plot | 1 | 95 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 4 Death of the baby (all stillbirths, neonatal and infant deaths) Show forest plot | 4 | 425 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.08 [0.69, 1.71] |
| 5 Death of the baby (subgrouped by time of death) Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.1 Stillbirth | 4 | 425 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.20 [0.03, 1.16] |
| 5.2 Perinatal death | 2 | 68 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.14 [0.45, 2.89] |
| 5.3 Neonatal death | 4 | 425 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.80, 2.23] |
| 5.4 Death after 28 days | 1 | 38 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.8 [0.18, 18.21] |
| 6 Intraventricular haemorrhage or hypoxic ischaemic encephalopathy Show forest plot | 1 | 262 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.82 [1.06, 3.14] |
| 7 Renal failure Show forest plot | 2 | 133 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.01, 6.97] |
| 8 Caesarean section Show forest plot | 4 | 425 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [1.01, 1.18] |
| 9 Placental abruption Show forest plot | 2 | 133 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.26, 2.40] |
| 10 Low Apgar score at five minutes (< 7 at five minutes) Show forest plot | 1 | 262 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.48 [0.87, 2.50] |
| 11 Neonatal seizures Show forest plot | 1 | 262 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.57 [0.27, 24.43] |
| 12 Hyaline membrane disease Show forest plot | 2 | 133 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.30 [1.39, 3.81] |
| 13 Necrotising enterocolitis Show forest plot | 3 | 395 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.10 [0.93, 4.79] |
| 14 Baby ventilated Show forest plot | 2 | 300 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.50 [1.11, 2.02] |
| 15 Measures of long‐term growth & development (cerebral palsy) Show forest plot | 1 | 262 | Risk Ratio (M‐H, Fixed, 95% CI) | 6.01 [0.75, 48.14] |
| 16 Measures of long‐term growth & development (poor hearing/hearing aid) Show forest plot | 1 | 262 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.34 [0.07, 1.74] |
| 17 Measures of long‐term growth & development (impaired vision) Show forest plot | 1 | 262 | Risk Ratio (M‐H, Fixed, 95% CI) | 4.29 [0.51, 36.22] |
| 18 Small‐for‐gestational age Show forest plot | 2 | 125 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.14, 0.65] |
| 19 Gestation at birth (days) Show forest plot | 4 | 425 | Mean Difference (IV, Random, 95% CI) | ‐9.91 [‐16.37, ‐3.45] |
| 20 Length of stay in neonatal intensive care unit (days) Show forest plot | 2 | 125 | Mean Difference (IV, Random, 95% CI) | 11.14 [1.57, 20.72] |
| 21 Admission to neonatal intensive care unit Show forest plot | 2 | 125 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.35 [1.16, 1.58] |
