The edition · Obstetrics & Gynaecology
In early pre-eclampsia, the drug chart and the urine protein both flag which women are at higher maternal risk
Two expectant-management cohorts point to prognostic signals already in the notes: how often the antihypertensive has been escalated, and how much protein is in the 24-hour collection.
The edition in brief
Two studies of expectant management in preterm pre-eclampsia point to signals clinicians already record. A US cohort of 396 women with early-onset pre-eclampsia with severe features found each additional oral antihypertensive dose escalation was associated with an absolute 4.2 percentage-point rise in a composite of serious maternal complications; three or more escalations carried roughly four to five times the risk of none. A secondary analysis of two South African trials found heavier proteinuria was associated with shorter latency (median 15.3 days below 3 g/24 h vs 4.9 days at 5 g or more) and more maternal complications (8.8% vs 27.9%), predicting about as well as the sFlt-1/PlGF ratio for maternal outcomes. Neither predicted neonatal outcomes. Both are observational and neither sets a delivery threshold. A meta-analysis of 17 trials found standalone exercise programmes in pregnancy were associated with lower depressive symptom scores, on low-certainty evidence, and a pooled UK analysis found that women who cut down early in pregnancy were more likely to reach abstinence by 36 weeks.
Heavier proteinuria meant shorter latency and more maternal harm in preterm pre-eclampsia
Quantify proteinuria in preterm pre-eclampsia and use it to set expectations for latency and maternal risk, not as a delivery trigger.
Standalone exercise in pregnancy was associated with lower depressive symptom scores
Encourage structured exercise in uncomplicated pregnancy as a possible support for mood, alongside — never instead of — depression screening and treatment.
Women who cut down early in pregnancy were more likely to stop smoking by 36 weeks
Ask about early cutting down and previous quit attempts at booking, and offer cessation support to the women already changing.
Magnesium sulphate toxicity is a bedside diagnosis
Hourly knee jerk, breathing rate and urine output are the safety monitoring for magnesium sulphate; calcium gluconate is the antidote.
Each antihypertensive escalation in early severe pre-eclampsia marked higher maternal risk
Count antihypertensive escalations during expectant management of early severe pre-eclampsia, and treat a rising count as disease progression.
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