![]() ![]() We hypothesized that women ineligible for EM will have greater short-term maternal morbidity compared to women that are expectantly managed, hence reinforcing guideline recommendations of no delay in delivery. Thus, we aimed to compare the additional postpartum maternal morbidity in women with preeclampsia with severe features in whom the ACOG recommends immediate delivery versus those eligible for EM. ![]() 8, 9 The magnitude of additional short-term postpartum maternal morbidity is not well defined in these women who are not candidates for EM. 10, 11Ĭurrent ACOG guidelines recommend immediate delivery in women with preeclampsia with severe features who have uncontrolled severe range blood pressures not responsive to antihypertensive medication development of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome persistent severe symptoms eclampsia and pulmonary edema among other conditions. 8, 9 These recommendations stem from evidence demonstrating improved neonatal outcomes with pregnancy prolongation when preeclampsia with severe features is diagnosed at <34 weeks of gestation, including lower neonatal intensive care (NICU) admissions, length of NICU stay, respiratory distress syndrome (RDS), and necrotizing enterocolitis (NEC). ![]() 3 Preeclampsia with severe features, occurring in 0.6% to 1.2% of pregnancies, represents the end of this disease spectrum.4, 5, 6, 7 Following the 2013 American College of Obstetricians and Gynecologists (ACOG) guideline revision for management of hypertension in pregnancy, expectant management (EM) of preeclampsia with severe features was recommended in select candidates at <34 weeks of gestation, provided the patient undergoes strict inpatient management with maternal and fetal surveillance until delivery. Preeclampsia complicates 3% of these pregnancies 1, 2 and is associated with considerable maternal and neonatal morbidities and mortalities. Hypertensive disorders of pregnancy occur in 5% to 10% of pregnancies in the United States. ![]()
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