There is insufficient data for clear guidelines in pregnancies
before 34 weeks gestation. In two randomized, controlled trials in
women with severe preeclampsia between 28-34 weeks or 28-32
weeks gestation, aggressive or expectant management was compared
and found that duration of gestation had been increased by 7.1 and 15
days, respectively [36,37]. A prospective observational trial published
in the American Journal of Obstetrics and Gynecology in 2004 studied
maternal and fetal outcomes with expectant management between 24
to 33 weeks [35]. The primary target of this study was the number
of days of gestation by which the pregnancy was prolonged after
admission [35]. Other maternal outcomes included death, eclampsia,
DIC, HELLP syndrome, pulmonary edema, placental abruption, and
acute renal failure [35]. Fetal outcomes included death, respiratory
distress syndrome, necrotizing enterocolitis, NICU admissions,
and days spent in NICU [35]. Nicardipine and labetalol were used
intravenously to maintain maternal blood pressure less than 150/110
mm Hg. Ultrasound, fetal heart rate monitoring, and twice daily
evaluation of fetal movements were used to assess fetal well-being
[35]. The study found that expectant management increased gestation by an average of six days for women less than 29 weeks gestation, and
four days for both the 29 to 32 week group, as well as the 32 to 33
week group [35]. During the study, there were no maternal deaths,
and 12 out of 13 perinatal deaths occurred in infants delivered before
29 weeks gestation [35]. The study found no significant differences in
maternal outcomes based on weeks gestation. Furthermore, expectant
management incurred minimal risks for the mother, but pregnancy
prolongation provides benefits for the fetus/neonate [35].