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Preeclampsia and Eclampsia Management on Stillbirths

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More Intervention Effect Estimate Summaries

Reference:
Jabeen M, Yakoob MY, Imdad A, Bhutta ZA. Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths.  BMC Public Health 2011 11 (Suppl 3):S6.

Background

  • Hypertensive disease of pregnancy (HDP) occurs in 5-8% of pregnancies, and leads to adverse perinatal outcomes like low birth weight, prematurity, stillbirth and intrauterine growth retardation. (1, 2)
  • Potential interventions for reducing the risk of developing preeclampsia during pregnancy include aspirin and calcium supplementation.  Similarly magnesium sulphate and anti-hypertensive drugs are among interventions for managing preeclampsia and eclampsia.

Intervention Effects

Calcium Supplementation on Stillbirths 

  • Calcium supplementation ranging from 1.5-2 g/day reduced stillbirths by 19% (95% ci: 0.63-1.03) in a population at risk of low calcium intake
  • Moderate quality of evidence – based on 3 randomized controlled trials
  • Further research is needed with assessment of the full range of pregnancy outcomes

Aspirin on Stillbirths 

  • No significant effect on risk of stillbirths (RR = 1.15; 95% CI: 0.88-1.49) among high-risk pregnancies
  • Low quality of evidence (21 RCTs) - No intervention recommendation

Anti-hypertensive Drugs on Stillbirths 

  • No significant effect on risk of stillbirths (RR = 1.14; 95% CI: 0.60-2.17) in pregnant women with mild to moderate hypertension
  • Moderate/Low quality of evidence (18 RCTs) - No intervention recommendation

Magnesium Sulphate on Stillbirths 

  • No significant effect on risk of stillbirths (RR = 0.99; 95% CI: 0.87-1.12) for pregnancies with preeclampsia
  • High/Moderate quality of evidence - No intervention recommendation

HDP Package on Stillbirths

  • Package includes use of an appropriate antihypertensive, magnesium supplementation (in case of preeclampsia/eclampsia) and availability of C-section when required.
  • Delphi consensus of 33 experts suggested a median effect of 20% reduction each in antepartum and intrapartum stillbirths (interquartile ranges of 10-30% and 10-40%, respectively). This was recommended for inclusion in the LiST model.

References from Jabeen Paper Cited Here:

  1. Yu CKH, P AT, parra M, Palma Das R, Nicolaides KH: Randomized controlled trial using low-dose aspirin in the prevention of pre-eclampsia in women with abnormal uterine Doppler at 23 weeks gestation.  Ultrasound in Obstetrics & Gynecology 2003, 22:233-239.  
  2. Italian Study of Aspirin in Pregnancy: Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hypertension. Lancet 1993, 341(8842):396-400.

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