Severe pre-eclampsia - query bank

Question: How should severe pre-eclampsia be managed?

Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.

 

Answer: The RCOG published a green-top guideline on the management of severe pre-eclampsia and eclampsia in 2006. (Evidence levels given throughout the guideline)

Two more recent Cochrane reviews were identified, but both found insufficient evidence to draw any conclusions:
A Cochrane review of "Interventionist versus expectant care for severe pre-eclampsia before term" (Churchill) found that there are insufficient data for any reliable recommendation about which policy of care should be used for women with severe early onset pre-eclampsia. One study has been identified, but not yet included in this review (Mesbah)
A Cochrane review of "Low-dose dopamine for women with severe pre-eclampsia"(Steyn) found no data on the use of low-dose dopamine in women with severe pre-eclampsia who have very low urine output.
A Cochrane review of "Induction of labour versus expectant management for pre-eclampsia at or near term" (Novikova) is in preparation.

The following guidelines, published more recently than the RCOG green-top, and which include severe pre-eclampsia were identified:

  • National Collaborating Centre for Women’s and Children’s Health. Commissioned by the National Institute for Health and Clinical Excellence  Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. (includes Chapter 10: Medical management of severe hypertension or severe pre-eclampsia in a critical care setting) (August 2010)
  • Society of Obstetricians and Gynaecologists of Canada. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy. (March 2008)

(Evidence levels given throughout the guidelines)

  • Society of Obstetric Medicine of Australia and New Zealand. Guidelines For The Management Of Hypertensive Disorders Of Pregnancy 2008
    (Evidence level IV)

A summary of evidence relating to the question "What are the effects of interventions in women who develop severe pre-eclampsia or very high blood pressure during pregnancy?" has also been published. (Duley)

References:

  • Churchill D, Duley L. Interventionist versus expectant care for severe pre-eclampsia before term. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003106. DOI: 10.1002/14651858.CD003106. Abstract (and full text in some countries). Full text available to RCOG Fellows, Members and Trainees. 
  • Pre-eclampsia, eclampsia, and hypertension. Lelia Duley. Clinical Evidence. Published 2011, based on search 2010
  • Mesbah EMM. Severe preterm preeclampsia: aggressive or expectant management?. Medical Journal of Cairo University 2003;71(1):175-82.
  • National Collaborating Centre for Women’s and Children’s Health. Commissioned by the National Institute for Health and Clinical Excellence. Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. London: RCOG , 2011 
  • Novikova N, Cluver C. Induction of labour versus expectant management for pre-eclampsia at or near term (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 8. Art. No.: CD009273. DOI: 10.1002/14651858.CD009273.  Abstract (and full text in some countries). Full text available to RCOG Fellows, Members and Trainees.
  • RCOG. Management of severe pre-eclampsia and eclampsia. Green-top guideline 10a. London: RCOG, 2006.
  • Society of Obstetric Medicine of Australia and New Zealand. Guidelines For The Management Of Hypertensive Disorders Of Pregnancy 2008
  • Society of Obstetricians and Gynaecologists of Canada. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy. Clinical Practice Guideline No. 206. J Obstet Gynaecol Can. 2008 Mar;30(3 Suppl):S1-48 
  • Steyn DW, Steyn P. Low-dose dopamine for women with severe pre-eclampsia. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD003515. DOI: 10.1002/14651858.CD003515.pub2.  Abstract (and full text in some countries). Full text available to RCOG Fellows, Members and Trainees.

Search date: September 2011

Classification of evidence levels

Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.

 

This clinical query answer was produced following the clinical query protocol as described here.

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Date published: 20/09/2011

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