Temporising versus interventionist management (preterm and at term)

Pre-eclampsia has a strong association with adverse outcomes: high incidences at term, and low incidences of morbidity; low incidences remote from term, high incidences of morbidity. The ultimate cure for pre-eclampsia is delivery of the placenta, but gestational age at delivery has an effect on perinatal outcome. We review aspects of two contrasting management approaches, and their indication areas are described (i.e. a more interventionist approach of stabilization (with antihypertensive drugs if needed and corticosteroids for acceleration of fetal lung maturation) and delivery, compared with a more temporizing approach, that treats the symptoms until delivery is necessary. In general, the temporizing approach has been shown to be safe, but beyond 37 weeks gestational age, there is evidence for better outcomes after early delivery. Below that gestational age, trials are awaited that help determine the balance in individual cases, depending on severity of maternal disease and fetal condition.