Should we offer expectant management in cases of severe preterm preeclampsia with fetal growth restriction?

Objective The purpose of this study was to assess maternal and fetal morbidity and death in cases of severe preterm preeclampsia that were managed expectantly. Study design It is a retrospective study that included 155 singleton pregnancies with severe preeclampsia at <34 weeks of gestation that were managed expectantly over a 10-year period. Perinatal outcomes of both mother and fetus were stratified according to gestational age and the severity of fetal growth restriction ≤3th percentile, 4th to 5th percentile, >5th to10th percentile, and >10th percentile. Results The mean gestational age at admission was 30.2 ± 2.4 weeks (range, 23.9-34.0 weeks). The mean latency period was 5.3 ± 5.2 days, with a perinatal mortality rate of 3.9%. Gestational age of <30 weeks of gestation was the strongest variable that affected perinatal outcome, whereas fetal growth restriction played a marginal role. Conclusion Expectant management is recommended strongly in fetuses at <30 weeks of gestation, irrespective of fetal growth restriction. Delivery should be considered at >30 weeks of gestation.