Severe pre-eclampsia occurring remote from term (mid trimester) is a decision making dilemma for the obstetrician. Although some obstetricians may choose to manage these patients conservatively, hoping to achieve fetal lung mature before delivery, the general recommendation is that women with severe pre-eclampsia should be delivered after stabilization to avert maternal complications.
Since the disease is progressive and there is no medical treatment, delivery is always in the best interest of the mother. However, while some institutions consider delivery to be definitive therapy for all cases, regardless of the gestational age, others recommend prolonging pregnancy in most cases of severely premature pre-eclamptic gestations until one of the following occurs: development of fetal lung maturity, development of fetal or maternal distress, or achievement of gestational age of 34 to 36 weeks of gestation.
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