Bibliographic Info
GuidelineWHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025
Year of Publication2023
Issuing InstitutionWorld Health Organization
Recommendation
Status
Maintained
Recommended in favor
Strong
Certainty of evidence
Very low
In women with severe pre-eclampsia, a viable fetus and before 34 weeks of gestation, a policy of expectant management is recommended, provided that uncontrolled maternal hypertension, increasing maternal organ dysfunction or fetal distress are absent and can be monitored
Notes and Remarks
- 1.A policy of expectant management usually includes intra-hospital care with steroids for fetal lung maturation, magnesium sulfate (as necessary), antihypertensive drugs (as necessary), and close maternal and fetal monitoring to identify indications for delivery (e.g. uncontrolled hypertension, deterioration in the condition of the mother and the fetus, including organ dysfunction and fetal distress). As part of expectant management, in-utero transfer to a tertiary-level centre with neonatal intensive care capacity should be considered. The decision on the route of delivery should be made on a case-by-case basis, taking into account, among other factors, gestational age, fetal and cervical status and urgency.
- 2.The guideline development group considered that the gestational age threshold for using expectant management in very preterm fetuses depends on the fetal viability status and on the anticipated prolongation of gestation with expectant management. The guideline development group acknowledged that the gestational age threshold of fetal viability should be locally agreed. In establishing this threshold, the local context, the availability of resources, and the local newborn survival rates by gestational age should be considered. The average gain in terms of prolongation of gestation with expectant management ranges from 1 week to 2 weeks. Hence, fetuses at a gestational age 1–2 weeks below the fetal viability threshold may benefit from expectant management
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
WHO recommendations: policy of interventionist versus expectant management of severe pre-eclampsia before term.
Year2018
InstitutionWorld Health Organization