1. Outcomes following medical termination versus prolonged pregnancy in women with severe preeclampsia before 26 weeks.
- Author
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Carvalho MA, Bejjani L, Francisco RPV, Patino EG, Vivanti A, Batista FS, Zugaib M, Mercier FJ, Bernardes LS, and Benachi A
- Subjects
- Adolescent, Adult, Brazil, Cesarean Section, Female, Fetal Death, France, Gestational Age, Humans, Middle Aged, Pregnancy, Retrospective Studies, Watchful Waiting, Young Adult, Abortion, Induced, Pre-Eclampsia epidemiology, Pregnancy Outcome
- Abstract
Objective: To compare maternal complications and describe neonatal outcomes in women with severe preeclampsia at ≤ 26+0 weeks in two countries with different management policies: expectant management (Brazil) versus termination of pregnancy (France)., Methods: We conducted a retrospective comparative study by reviewing the medical records of women with severe preeclampsia at ≤ 26+0 weeks, from January 2010 to June 2018, in two centers: Hospital das Clínicas da Faculdade de Medicina, in Sao Paulo, Brazil (where medical abortion is forbidden in this indication) and Hôpital Antoine-Béclère, Clamart, France (where medical termination is accepted). We collected information on maternal characteristics, laboratory tests, maternal complications and fetal and newborn characteristics. We used Student's t-test and the Mann-Whitney U nonparametric test to compare quantitative variables, and Chi-square test or Fisher's exact test to evaluate the associations between the qualitative variables., Results: There was no between-group difference in maternal complications during hospitalization (p = 0.846). In Brazil, the rate of cesarean section was 66.7%, and 20% of patients had vertical incision. The rate of spontaneous fetal death was 35.6% and among the live-born infants 26.6% were discharged from hospital. In France, one patient had a cesarean section with vertical incision., Conclusion: When comparing termination of pregnancy to expectant management in severe preeclampsia before 26 weeks, maternal complications were equivalent but maternal reproductive future might have been compromised in 20% of cases due to a higher risk of uterine rupture in subsequent pregnancies for patients having classic cesarean (vertical incision). 26.6% of children survived the neonatal period when pregnancy was pursued, however we lack information on their long-term follow-up., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2021
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