PREECLAMPSIA SEVERA: MANEJO CONSERVADOR VS MANEJO AGRESIVO

Hernando Velasco S.; Stefany Whiteman R.

Submitted October 18, 2024

Published 2026-04-06

Artículos de Investigación

Vol. 18 No. 2 (2005): Revista Médico Científica

SEVERE PREECLAMPSIA: CONSERVATIVE MANAGEMENT VS AGRESSIVE MANAGEMENT

Hernando Velasco S.⁺⁻
Stefany Whiteman R. ⁺⁻

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Published: 2026-04-06

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Abstract

Preeclampsia is a disorder that often complicates pregnancies. It is considered severe when the systolic blood pressure is ? 160 mmHg or the dyastolic blood pressure ? 110 mmHg. Severe preeclampsia is associated with a progressive damage of maternal condition. Interruption of pregnancy is broadly accepted as a definitive treatment when maternal or fetal condition is altered or when pregnancy has reached 34 weeks. Nevertheless, in earlier stages, the handling is controversial, because the interruption is associated to a worse neonatal outcome.

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References

Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183(1)
.
Wagner L. Diagnosis and Management of Preeclampsia, Am Fam Physician 2004 Dec 15;70:2317-24.
Lyell DJ, Lambert-Messerlian GM, Giudice LC. Prenatal screening, epidemiology, diagnosis, and management of preeclampsia. Clinics in Laboratory Medicine. 2003 Jun; 23(2).
De Groot CJ, Bloemenkamp KW, Duvekot EJ, et al. Preeclampsia and genetic risk factors for thrombosis: a case-control study. Am J Obstet Gynecol 1999;181:975-80.
American College of Obstetricians and Gynecologists. Hypertension in pregnancy. ACOG Technical Bulletin Washington, DC. 1996:1-8.
ACOG Committee on Obstetric Practice. Diagnosis and management of preeclampsia and eclampsia. ACOG practice bulletin. No. 33, January 2002. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;99:159-67.
Sibai BM et al. Risk factors for preeclampsia in healthy nulliparous women: A prospective multicenter study. Am J Obstet Gynecol 1995;172:642-8.
Cotler AM, Molloy AM, Scott JM, Daly SF. Elevated plasma homocysteine in early pregnancy: A risk factor for the development of severe preeclampsia. Am J Obstet Gynecol 2001 Oct;185(4):781-5.
Chapell LC et al. A longitudinal study of biochemical variables in women at risk of preeclampsia. Am J Obstet Gynecol 2002 Jul;187(1):127-36.
Zhou Y, Damsky CH, Fisher SJ. Preeclampsia is associated with failure of human cytotrophoblasts to mimic a vascular adhesion phenotype. One cause of defective endovascular invasion in this syndrome? J Clin Invest 1997;99:2152-2164.
Davison JM et al. New aspects in the pathophysiology of preeclampsia. J Am Nephrology 2004 Sept;15(9).
Lim KH, Zhou Y, Janatpour M, McMaster M, Bass K, Chun SH, Fisher SJ. Human cytotrophoblast differentiation/invasion is abnormal in preeclampsia. Am J Pathol 1997;151:1809-1818.
Postovit LM, Adams MA, Graham CH. Does nitric oxide play a role in the aetiology of preeclampsia? Placenta. 2001 Apr;22.
Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol 1998;179:1359-75.
Roberts JM, Cooper DW. Pathogenesis and genetics of preeclampsia. Lancet 2001;357:53-6.
Einarsson JI, Sangi-Haghpeykar H, Gardner MO. Sperm exposure and development of preeclampsia. Am J Obstet Gynecol 2003 May;188(5):1241-3.
Sibai BM, Ramadan MK, Chari RS, Friedman SA. Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol 1995;172(1 pt 1):125-9.
Padden MO. HELLP syndrome: recognition and perinatal management. Am Fam Physician 1999;60:829-36,839.
Schwarcz RL, Quiverges CA, Diaz AG, Fescina RH. Obstetricia. 5ta ed. Buenos Aires: El Ateneo; 2003. p. 261.
Schiff E, Friedman SA, Kao L, Sibai BM. The importance of urinary protein excretion during conservative management of severe preeclampsia. Am J Obstet Gynecol 1996 Nov;175(5):1313.
Haddad B, Deis S, Goffinet F, Paniel BJ, Cabrol D, Sibai BM. Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks' gestation. Am J Obstet Gynecol 2004 Jun;190(6).
Many A, Kuperminc MJ, Pausner O, Lessing JB. Treatment of severe preeclampsia remote from term: a clinical dilemma. Obstet Gynecol Surv 1999 Nov;54(11):723-7.
Sibai BM, Taslimi M, Abdella TN, Brooks TF, Spinnato JA, Anderson GD. Maternal and perinatal outcome of conservative management of severe preeclampsia in midtrimester. Am J Obstet Gynecol 1985;152:32-7.
Sibai BM, Akl S, Fairlie F, Moretti M. A protocol for managing severe preeclampsia in the second trimester. Am J Obstet Gynecol 1990;163:733-8.
Moodley J, Koranteng SA, Rout C. Expectant management of early onset severe preeclampsia in Durban. S Afr Med J 1993;83:584-7.
Visser W, Wallenburg HCS. Maternal and perinatal outcome of temporizing management in 254 consecutive patients with severe preeclampsia remote from term. Eur J Obstet Gynecol Reprod Biol 1995;63:147-54.
Pattinson RC, Odendaal HJ, DuToit R. Conservative management of severe proteinuric hypertension before 28 weeks' gestation. S Afr Med J 1988;73:516-8.
Jenkins SM, Head BB, Hauth JC. Severe preeclampsia at <25 weeks of gestation: Maternal and neonatal outcomes. Am J Obstet Gynecol 2002 Apr;186(4).
Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial. Am J Obstet Gynecol 1994 Sep;171(3):818-22.
Shear RM, Rinfret O, Leduc L. Should we offer expectant management in cases of severe preterm preeclampsia with fetal growth restriction? Am J Obstet Gynecol 2005 Apr;192(4).
Chammas MF, Nguyen TM, Li MA, Nuwayhid BS, Castra LC. Expectant management of severe pre-eclampsia: is intrauterine growth restriction an indication for immediate delivery? Am J Obstet Gynecol 2000;183:853-8.
Begum MR, Akhter S, Begum A, Khatun M, Quadir E, Choudhury SB. Conservative management of eclampsia and severe preeclampsia: A Bangladesh experience. Medscape Womens Health 2002;7(1):1.
Vigil-De Gracia P, Montufar-Rueda C, Ruiz J. Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks' gestation. Eur J Obstet Gynecol Reprod Biol 2003 Mar 23;107(1):24-7.
Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 1995;333:201-205.
Ramanathan J, Bennett K. Pre-eclampsia: fluids, drugs, and anesthetic management. Anesthesiology Clinics of North America 2003 Mar;21(1).
Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med 1996;335:257-265.

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[1] Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183(1)

[2] .

[3] Wagner L. Diagnosis and Management of Preeclampsia, Am Fam Physician 2004 Dec 15;70:2317-24.

[4] Lyell DJ, Lambert-Messerlian GM, Giudice LC. Prenatal screening, epidemiology, diagnosis, and management of preeclampsia. Clinics in Laboratory Medicine. 2003 Jun; 23(2).

[5] De Groot CJ, Bloemenkamp KW, Duvekot EJ, et al. Preeclampsia and genetic risk factors for thrombosis: a case-control study. Am J Obstet Gynecol 1999;181:975-80.

[6] American College of Obstetricians and Gynecologists. Hypertension in pregnancy. ACOG Technical Bulletin Washington, DC. 1996:1-8.

[7] ACOG Committee on Obstetric Practice. Diagnosis and management of preeclampsia and eclampsia. ACOG practice bulletin. No. 33, January 2002. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;99:159-67.

[8] Sibai BM et al. Risk factors for preeclampsia in healthy nulliparous women: A prospective multicenter study. Am J Obstet Gynecol 1995;172:642-8.

[9] Cotler AM, Molloy AM, Scott JM, Daly SF. Elevated plasma homocysteine in early pregnancy: A risk factor for the development of severe preeclampsia. Am J Obstet Gynecol 2001 Oct;185(4):781-5.

[10] Chapell LC et al. A longitudinal study of biochemical variables in women at risk of preeclampsia. Am J Obstet Gynecol 2002 Jul;187(1):127-36.

[11] Zhou Y, Damsky CH, Fisher SJ. Preeclampsia is associated with failure of human cytotrophoblasts to mimic a vascular adhesion phenotype. One cause of defective endovascular invasion in this syndrome? J Clin Invest 1997;99:2152-2164.

[12] Davison JM et al. New aspects in the pathophysiology of preeclampsia. J Am Nephrology 2004 Sept;15(9).

[13] Lim KH, Zhou Y, Janatpour M, McMaster M, Bass K, Chun SH, Fisher SJ. Human cytotrophoblast differentiation/invasion is abnormal in preeclampsia. Am J Pathol 1997;151:1809-1818.

[14] Postovit LM, Adams MA, Graham CH. Does nitric oxide play a role in the aetiology of preeclampsia? Placenta. 2001 Apr;22.

[15] Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol 1998;179:1359-75.

[16] Roberts JM, Cooper DW. Pathogenesis and genetics of preeclampsia. Lancet 2001;357:53-6.

[17] Einarsson JI, Sangi-Haghpeykar H, Gardner MO. Sperm exposure and development of preeclampsia. Am J Obstet Gynecol 2003 May;188(5):1241-3.

[18] Sibai BM, Ramadan MK, Chari RS, Friedman SA. Pregnancies complicated by HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): subsequent pregnancy outcome and long-term prognosis. Am J Obstet Gynecol 1995;172(1 pt 1):125-9.

[19] Padden MO. HELLP syndrome: recognition and perinatal management. Am Fam Physician 1999;60:829-36,839.

[20] Schwarcz RL, Quiverges CA, Diaz AG, Fescina RH. Obstetricia. 5ta ed. Buenos Aires: El Ateneo; 2003. p. 261.

[21] Schiff E, Friedman SA, Kao L, Sibai BM. The importance of urinary protein excretion during conservative management of severe preeclampsia. Am J Obstet Gynecol 1996 Nov;175(5):1313.

[22] Haddad B, Deis S, Goffinet F, Paniel BJ, Cabrol D, Sibai BM. Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks' gestation. Am J Obstet Gynecol 2004 Jun;190(6).

[23] Many A, Kuperminc MJ, Pausner O, Lessing JB. Treatment of severe preeclampsia remote from term: a clinical dilemma. Obstet Gynecol Surv 1999 Nov;54(11):723-7.

[24] Sibai BM, Taslimi M, Abdella TN, Brooks TF, Spinnato JA, Anderson GD. Maternal and perinatal outcome of conservative management of severe preeclampsia in midtrimester. Am J Obstet Gynecol 1985;152:32-7.

[25] Sibai BM, Akl S, Fairlie F, Moretti M. A protocol for managing severe preeclampsia in the second trimester. Am J Obstet Gynecol 1990;163:733-8.

[26] Moodley J, Koranteng SA, Rout C. Expectant management of early onset severe preeclampsia in Durban. S Afr Med J 1993;83:584-7.

[27] Visser W, Wallenburg HCS. Maternal and perinatal outcome of temporizing management in 254 consecutive patients with severe preeclampsia remote from term. Eur J Obstet Gynecol Reprod Biol 1995;63:147-54.

[28] Pattinson RC, Odendaal HJ, DuToit R. Conservative management of severe proteinuric hypertension before 28 weeks' gestation. S Afr Med J 1988;73:516-8.

[29] Jenkins SM, Head BB, Hauth JC. Severe preeclampsia at <25 weeks of gestation: Maternal and neonatal outcomes. Am J Obstet Gynecol 2002 Apr;186(4).

[30] Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks' gestation: a randomized controlled trial. Am J Obstet Gynecol 1994 Sep;171(3):818-22.

[31] Shear RM, Rinfret O, Leduc L. Should we offer expectant management in cases of severe preterm preeclampsia with fetal growth restriction? Am J Obstet Gynecol 2005 Apr;192(4).

[32] Chammas MF, Nguyen TM, Li MA, Nuwayhid BS, Castra LC. Expectant management of severe pre-eclampsia: is intrauterine growth restriction an indication for immediate delivery? Am J Obstet Gynecol 2000;183:853-8.

[33] Begum MR, Akhter S, Begum A, Khatun M, Quadir E, Choudhury SB. Conservative management of eclampsia and severe preeclampsia: A Bangladesh experience. Medscape Womens Health 2002;7(1):1.

[34] Vigil-De Gracia P, Montufar-Rueda C, Ruiz J. Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks' gestation. Eur J Obstet Gynecol Reprod Biol 2003 Mar 23;107(1):24-7.

[35] Lucas MJ, Leveno KJ, Cunningham FG. A comparison of magnesium sulfate with phenytoin for the prevention of eclampsia. N Engl J Med 1995;333:201-205.

[36] Ramanathan J, Bennett K. Pre-eclampsia: fluids, drugs, and anesthetic management. Anesthesiology Clinics of North America 2003 Mar;21(1).

[37] Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med 1996;335:257-265.

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