Key result
IV methylprednisolone fails to prolong the entry to delivery interval versus placebo in early-onset preeclampsia.
Why the study?
The outcomes of expectant management of preterm preeclampsia and the effect of ongoing methylprednisolone treatment on maternal and perinatal outcomes in Indonesia were not well established.
Does ongoing treatment with methylprednisolone prolong the entry to delivery interval in patients with early-onset preeclampsia?
RCT (n=48)
randomized
No
Does ongoing treatment with methylprednisolone prolong the entry to delivery interval in patients with early-onset preeclampsia?
Absolute Event Rate: 13.7% vs 13.8%
Ongoing treatment with methylprednisolone does not prolong pregnancy in early-onset preeclampsia and may increase the risk of severe maternal infections.
Ongoing methylprednisolone adds no benefit in expectant preterm preeclampsia management and may increase maternal infection risk; challenges routine steroid use beyond fetal lung maturation.
OBJECTIVE: To present the outcome of expectant management of preterm preeclampsia in Indonesia, and the effect of ongoing treatment with methylprednisolone (MP) on maternal and perinatal outcome. MATERIAL AND METHODS: Prospective RCT on 48 patients with early-onset preeclampsia. Following the administration of dexamethasone for fetal lung maturation, patients were randomized to receive 25 mg MP group IV for the first week, decreasing to 12.5 mg during 2nd week and continued till birth, or matching IV placebo treatment (PL group). Prolongation of entry to delivery interval served as primary outcome measurement. RESULTS: The average time gained with expectant management was almost 14 days. However, there was no difference of mean time interval between entry to delivery between the PL (13.8 days) and MP (13.7 days) groups. Antenatal ongoing treatment with IV MP also did not improve maternal and/or perinatal outcome and might be associated with a higher risk for severe maternal infections--in particular tuberculosis. CONCLUSION: Expectant management of preterm preeclampsia is a realistic option in a major Indonesian perinatal referral center. Steroids (outside the use for fetal lung maturation) should not be used in the expectant management of preterm preeclampsia in Indonesia.
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Ernawati et al. (2015) conducted an RCT in early-onset preeclampsia (n=48). Methylprednisolone vs. Placebo was evaluated on Prolongation of entry to delivery interval. Intravenous methylprednisolone did not prolong the entry to delivery interval compared to placebo (13.7 vs 13.8 days) in patients with early-onset preeclampsia.
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