Expert opinion: exceptions to rule of delivery for severe preeclampsia.(Obstetrics)

LAS VEGAS -- There are at least three exceptions to the general rule of delivery for severe preeclampsia regardless of gestational age, Dr. Errol R. Norwitz said at the Fifth World Congress on Controversies in Obstetrics, Gynecology, and Infertility.

According to the American College of Obstetricians and Gynecologists, preeclampsia is considered severe if at least one of a series of criteria is present. In certain circumstances, three of these criteria may not necessitate immediate delivery, said Dr. Norwitz, director of the division of maternal-fetal medicine in the department of obstetrics, gynecology, and reproductive sciences at Yale-New Haven Hospital, New Haven.

* Diagnosis based solely on proteinuria (more than 5 g/24 hours). "It's clear that the extent of proteinuria does not affect either maternal or perinatal morbidity and mortality. There is a weak association with placental abruption. It's unclear why that is, but it doesn't correlate with pregnancy outcome," Dr. Norwitz said.

He added that he found it "very disappointing" that ACOG included proteinuria as a criterion for severe preeclampsia in its Practice Bulletin No. 33, which was published in 2002.

* Diagnosed before 32 weeks solely on the basis of intrauterine growth restriction with good fetal test results. "You don't necessarily want to deliver that baby if the baby's tested well," he said. "I recommend managing these patients as an inpatient with daily fetal testing. However, the chance that you actually extend a pregnancy by doing this is very low. The admission-to-delivery interval in such pregnancies averages 3 days, and over 85% will require delivery within 1 week."

* Diagnosed before 32 weeks solely on the basis of blood pressure criteria. Hypertension is a clinical feature, not the underlying cause of preeclampsia, he said.

"In fact, there is a lot of debate as to why these patients get hypertensive. The prevailing theory is that maternal ...