Department of Obstetrics and Gynecology, Universidad Nacional de Colombia, Bogotá, Colombia.
Rev Bras Ginecol Obstet. 2021 Aug;43(8):627-637. doi: 10.1055/s-0041-1733999. Epub 2021 Sep 21.
To compare the effects of expectant versus interventionist care in the management of pregnant women with severe preeclampsia remote from term.
An electronic search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILACS, for its Spanish acronym), World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP), and OpenGrey databases. The International Federation of Gynecology and Obstetrics (FIGO, for its French acronym), Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and () websites were searched for conference proceedings, without language restrictions, up to March 25, 2020.
Randomized clinical trials (RCTs), and non-randomized controlled studies (NRSs) were included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of the evidence.
Studies were independently assessed for inclusion criteria, data extraction, and risk of bias. Disagreements were resolved by consensus.
Four RCTs and six NRS were included. Low-quality evidence from the RCTs showed that expectant care may result in a lower incidence of appearance, pulse, grimace, activity, and respiration (Apgar) scores < 7 at 5 minutes (risk ratio [RR]: 0.48; 95% confidence interval [95%CI]: 0.23%to 0.99) and a higher average birth weight (mean difference [MD]: 254.7 g; 95%CI: 98.5 g to 410.9 g). Very low quality evidence from the NRSs suggested that expectant care might decrease the rates of neonatal death (RR: 0.42; 95%CI 0.22 to 0.80), hyaline membrane disease (RR: 0.59; 95%CI: 0.40 to 0.87), and admission to neonatal care (RR: 0.73; 95%CI: 0.54 to 0.99). No maternal or fetal differences were found for other perinatal outcomes.
Compared with interventionist management, expectant care may improve neonatal outcomes without increasing maternal morbidity and mortality.
比较期待治疗与干预性治疗在管理远足月重度子痫前期孕妇中的效果。
电子检索 MEDLINE（医学文献分析和检索系统在线）、EMBASE（荷兰医学文摘）、Cochrane 对照试验中心注册库（CENTRAL）、拉丁美洲和加勒比健康科学文献数据库（LILACS，西班牙语缩写）、世界卫生组织国际临床试验注册平台（WHO-ICTRP）和 OpenGrey 数据库。国际妇产科联合会（FIGO，法语缩写）、英国皇家妇产科学院（RCOG）、美国妇产科医师学会（ACOG）和 （）网站搜索会议记录，无语言限制，检索截至 2020 年 3 月 25 日。
纳入随机临床试验（RCT）和非随机对照研究（NRS）。采用推荐分级、评估、制定与评价（GRADE）方法评估证据质量。
研究独立评估纳入标准、数据提取和偏倚风险。意见分歧通过协商解决。
纳入 4 项 RCT 和 6 项 NRS。来自 RCT 的低质量证据表明，期待治疗可能导致 5 分钟时 Apgar 评分＜7 的发生率较低（风险比[RR]：0.48；95%置信区间[95%CI]：0.23%至 0.99）和平均出生体重较高（平均差值[MD]：254.7 g；95%CI：98.5 g 至 410.9 g）。来自 NRS 的极低质量证据表明，期待治疗可能降低新生儿死亡率（RR：0.42；95%CI 0.22 至 0.80）、透明膜病（RR：0.59；95%CI：0.40 至 0.87）和新生儿护理入院率（RR：0.73；95%CI：0.54 至 0.99）。在其他围产期结局方面，未发现母婴差异。
与干预性治疗相比，期待治疗可能改善新生儿结局，而不增加母婴发病率和死亡率。
