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Antepartum eclampsia <34 weeks case series: advisable to postpone delivery to administer corticosteroids for fetal pulmonary benefit?

Journal of Perinatology volume 31, pages 161–165 (2011)Cite this article

Subjects

Abstract

Objective:

To determine if postponement of delivery to administer fetal lung maturation corticosteroids (PDACs) in mothers with antepartum eclampsia <34 weeks gestation benefits the fetus without compromising the mother.

Study Design:

A case series of 37 maternal–perinatal pairs over a 9-year period with antepartum eclampsia between 24 and 34 weeks gestation from a single tertiary center were reviewed retrospectively. Duration of PDAC, clinical course and maternal–fetal outcomes, including impact of duration of PDAC on neonatal pulmonary function, were recorded for each case. Group assignment was based on length of corticosteroid treatment course before delivery: Group A, 0 to ⩽24 h, n=28; B, 24 to <48 h, n=5; C, ⩾48 h, n=4. Data were collected and analyzed by one-way analysis of variance (ANOVA), ANOVA on ranks, χ2-test and Fisher's exact tests where appropriate; statistical significance was determined by a P-value <0.05.

Result:

Overall, 37 of 68 eclampsia patients in 1999 to 2007 met inclusion criteria. No adverse maternal or fetal event occurred while delivery was postponed. Immediate neonatal intubation or continuous positive airway pressure was required for 23/28 in A, 4/5 in B and 2/4 in C; room air was sufficient at birth for 5/28 in A, 1/5 in B and 2/4 in C. No newborn >33 weeks gestation required INI. Prolonged (that is, >1 day) mechanical ventilation was not required for any infant with a gestational age ⩾32 weeks or PDAC ⩾48 h. Two of three neonatal deaths in group A were attributed to pulmonary insufficiency.

Conclusion:

PDAC for antepartum preterm eclampsia, especially ⩽32 weeks gestation, appears to offer notable fetal pulmonary benefit without significantly increasing maternal or fetal risk.

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References

  1. Knight M, on behalf of UKOSS. Eclampsia in the United Kingdom 2005. BJOG 2007; 114: 1072–1078.

    Article  CAS  Google Scholar 

  2. Filippi V, Ronsmans C, Gandaho T, Graham W, Alihonou E, Santos P . Women's reports of severe (near-miss) obstetric complications in Benin. Stud Fam Plann 2000; 31: 309–324.

    Article  CAS  Google Scholar 

  3. Leitch CR, Cameron AD, Walker JJ . The changing patterns of eclampsia over a 60-year period. BJOG 1997; 104: 917–922.

    Article  CAS  Google Scholar 

  4. Caetano M, Ornstein MP, von Dadelszen P, Hannah ME, Logan AG, Gruslin A et al. A survey of Canadian practitioners regarding diagnosis and evaluation of the hypertensive disorders of pregnancy. Hyperten Preg 2004; 23: 197–209.

    Article  CAS  Google Scholar 

  5. Aagaard-Tillery KM, Belfort MA . Eclampsia: morbidity, mortality, and management. Clin Obstet Gynecol 2005; 48: 12–23.

    Article  Google Scholar 

  6. Norwitz ER . Eclampsia. UpToDate v 16.2, 31 May 2008.

  7. Karumanchi SA, Lindheimer MD . Advances in the understanding of eclampsia. Curr Hypertens Rep 2008; 10: 305–312.

    Article  Google Scholar 

  8. Moodley J, Kalane G . A review of the management of eclampsia: practical issues. Hyperten Preg 2006; 25: 47–62.

    Article  CAS  Google Scholar 

  9. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. Effect of corticosteroids for fetal maturation on perinatal outcomes. JAMA 1995; 273: 413–418.

    Article  Google Scholar 

  10. Write LL, Horbar JD, Gunkel H, Verter J, Younes N, Andrews EB et al. Evidence from multicenter networks on the current use and effectiveness of antenatal corticosteroids in low birth weight infants. Am J Obstet Gynecol 1995; 173: 263–269.

    Article  Google Scholar 

  11. Crowley PA . Antenatal corticosteroid therapy: a meta-analysis of the randomized trials 1972–1994. Am J Obstet Gynecol 1995; 173: 322–335.

    Article  CAS  Google Scholar 

  12. Ment L, Oh W, Ehrenkranz RA, Philip AG, Duncan CC, Makuch RW . Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants. Am J Obstet Gynecol 1995; 172: 795–800.

    Article  CAS  Google Scholar 

  13. Shanrakan S, Bauer CR, Bain R, Write L, Zachary J . Relationship between antenatal steroid administration and grades III and IV intracranial hemorrhage in preterm infants. Am J Obstet Gynecol 1995; 173: 305–312.

    Article  Google Scholar 

  14. Friedman S, Shinwell ES . Prenatal and postnatal steroid therapy and child neurodevelopment. Clin Perinatal 2004; 31: 529–544.

    Article  CAS  Google Scholar 

  15. Chang EY, Menard MK, Vermillion ST, Hulsey E, Ebeling M . The association between hyaline membrane disease and preeclampsia. Am J Obstet Gynecol 2004; 191: 1414–1417.

    Article  Google Scholar 

  16. ACOG Practice Bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002.

  17. Andersen WA, Harbert Jr GM . Conservative management of pre-eclamptic and eclamptic patients: a re-evaluation. Am J Obstet Gynecol 1977; 129: 260–266.

    Article  CAS  Google Scholar 

  18. Sibai BM . Diagnosis, prevention and management of eclampsia. Obstet Gynecol 2005; 105: 402–410.

    Article  Google Scholar 

  19. Von Dadelszen P, Menzie J, Gilgoff S, Xie F, Douglas MJ, Sawchuck D, et al. Evidence-based management for preeclampsia. Front Biosci 2007; 12: 2876–2889.

    Article  CAS  Google Scholar 

  20. Lowe SA, Brown MA, Dekker GA, Gatt S, McLintock CK, McMahon LP et al. Guidelines for the management of hypertensive disorders of pregnancy 2008. Austr NZJ Obstet Gynaecol 2009; 49: 242–246.

    Article  Google Scholar 

  21. Ballard PL, Ballard RA . Scientific basis and therapeutic regimens for use of antenatal glucocorticoids. Am J Obstet Gynecol 1995; 173: 254–262.

    Article  CAS  Google Scholar 

  22. Crowley P . Prophylactic corticosteroids for preterm birth. Cochrane Database Syst Rev 2000; (2): CD000065.

  23. Figueras-Aloy J, Serrano MM, Rodriguez JP, Perez CF, Serrradilla VR, Jimenez JQ, et al., the SEN1500 Spanish Neonatal Network. Antenatal glucocorticoid treatment decreases mortality and chronic lung disease in survivors among 23- to 28-week gestational age preterm infants. Am J Perinatol 2005; 22: 441–448.

    Article  Google Scholar 

  24. Crowley P, Chalmers I, Keirse MJNC . The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. BJOG 1990; 97: 11–25.

    Article  CAS  Google Scholar 

  25. Lin C, Tsai M, Chou S, Yeh T . Effect of antenatal dexamethasone on the expression of endothelial nitric oxide synthase in the lungs of postnatal pups. Sem Perinatol 2001; 25: 94–99.

    Article  CAS  Google Scholar 

  26. Demarini S, Dollberg S, Hoath SB, Ho M, Donovan EF . Effect of antenatal corticosteroids on blood pressure in very low birth weight infants during the first 24 h of life. J Perinatal 1999; 19: 419–425.

    Article  CAS  Google Scholar 

  27. The Magpie Trial Collaborative Group. Do women with pre-eclampsia, and their babies, benefit from magnesium sulfate? The Magpie Trial: a randomized placebo-controlled trial. Lancet 2002; 359: 1877–1890.

    Article  Google Scholar 

  28. Crowther CA, Hiller JE, Doyle LW, Haslam RR, for the Australasian Collaborative Trial of Magnesium Sulphate Collaborative Group. Effect of magnesium sulfate given for neuroprotection before preterm birth: a randomized controlled trial. JAMA 2003; 290: 2669–2676.

    Article  CAS  Google Scholar 

  29. Scardo JA, Hogg BB, Newman RB . Favorable hemodynamic effects of magnesium sulfate in preeclampsia. Am J Obstet Gynecol 1995; 173: 1249–1253.

    Article  CAS  Google Scholar 

  30. Harandou M, Madani N, La bibe S, Messouak O, Boujraf S, Bekirane S et al. Neuroimaging findings in eclamptic patients still symptomatic after 24 h: a descriptive study about 19 cases. Ann Fr Anesth Reanim 2006; 25: 577–583.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Winfred L Wiser Hospital for Women and Infants, University of Mississippi Medical Center, Jackson, MS, USA

    K B Tam Tam, S D Keiser, S Sims, J Brewer, M Y Owens & J N Martin Jr

Authors
  1. K B Tam Tam
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  2. S D Keiser
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  3. S Sims
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  4. J Brewer
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  5. M Y Owens
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  6. J N Martin Jr
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Corresponding author

Correspondence to J N Martin Jr.

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The authors declare no conflict of interest.

Additional information

These data were presented at the 30th Annual Meeting of the Society for Maternal–Fetal Medicine: The Pregnancy Meeting, February 2010, Chicago, IL, USA.

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Tam Tam, K., Keiser, S., Sims, S. et al. Antepartum eclampsia <34 weeks case series: advisable to postpone delivery to administer corticosteroids for fetal pulmonary benefit?. J Perinatol 31, 161–165 (2011). https://doi.org/10.1038/jp.2010.118

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  • DOI: https://doi.org/10.1038/jp.2010.118

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