Guidelines for the management of women with severe pre-eclampsia

Marie-Pierre Bonnet; Marc Garnier; Hawa Keita; Vincent Compère; Chloé Arthuis; Tiphaine Raia-Barjat; Paul Berveiller; Julien Burey; Lionel Bouvet; Marie Bruyère; Adeline Castel; Elodie Clouqueur; Max Gonzalez Estevez; Valentina Faitot; Catherine Fischer; Florent Fuchs; Edouard Lecarpentier; Agnès Le Gouez; Agnès Rigouzzo; Mathias Rossignol; Emmanuel Simon; Florence Vial; Alexandre J Vivanti; Laurent Zieleskiewicz; Céline Camilleri; Marie-Victoire Sénat; Thomas Schmitz; Loïc Sentilhes

doi:10.1016/j.accpm.2021.100901

Guidelines for the management of women with severe pre-eclampsia

Anaesth Crit Care Pain Med. 2021 Oct;40(5):100901. doi: 10.1016/j.accpm.2021.100901. Epub 2021 Oct 1.

Authors

Marie-Pierre Bonnet¹, Marc Garnier², Hawa Keita³, Vincent Compère⁴, Chloé Arthuis⁵, Tiphaine Raia-Barjat⁶, Paul Berveiller⁷, Julien Burey², Lionel Bouvet⁸, Marie Bruyère⁹, Adeline Castel¹⁰, Elodie Clouqueur¹¹, Max Gonzalez Estevez¹², Valentina Faitot¹³, Catherine Fischer¹⁴, Florent Fuchs¹⁵, Edouard Lecarpentier¹⁶, Agnès Le Gouez¹⁷, Agnès Rigouzzo¹⁸, Mathias Rossignol¹⁹, Emmanuel Simon²⁰, Florence Vial²¹, Alexandre J Vivanti²², Laurent Zieleskiewicz²³, Céline Camilleri²⁴, Marie-Victoire Sénat²⁵, Thomas Schmitz²⁶, Loïc Sentilhes²⁷

Affiliations

¹ Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France. Electronic address: [email protected].
² Sorbonne Université, APHP, GRC 29, DMU DREAM, Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, Paris, France.
³ Université de Paris, Department of Anaesthesiology and Intensive Care, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁴ Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France.
⁵ Department of Obstetrics and Gynaecology, Nantes University Hospital, Mother and Child Hospital, Nantes, France.
⁶ Department of Gynaecology, Obstetrics, and Reproductive Medicine, Saint Etienne University Hospital, Université de Saint Etienne Jean Monnet, INSERM, U 1059 SainBioSE, F-42023 Saint Etienne, France.
⁷ Department of Obstetrics and Gynaecology - Poissy Saint-Germain Hospital, Poissy, France; Université Paris-Saclay, UVSQ, INRAE, BREED, Jouy-en-Josas, France; Ecole Nationale Vétérinaire d'Alfort, BREED, Maison-Alfort, France.
⁸ Department of Anaesthesiology and Intensive Care, Mother and Child Hospital, Hospices Civils de Lyon, Bron, France; Université de Lyon, Claude Bernard Lyon 1, Villeurbanne, France.
⁹ Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, Le Kremlin- Bicêtre, France.
¹⁰ Department of Anaesthesiology and Intensive Care, Paule de Viguier University Hospital, Toulouse, France.
¹¹ Department of Obstetrics and Gynaecology, Tourcoing Hospital, France.
¹² Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Jeanne de Flandre Maternity Hospital, Lille University Hospital, Lille, France.
¹³ Department of Anaesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
¹⁴ Department of Anaesthesiology and Intensive Care, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁵ Department of Obstetrics and Gynaecology, Montpellier University Hospital, Arnaud de Villeneuve Hospital, Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique (IDESP), UMR INSERM - Université de Montpellier, Campus Santé, IURC, Montpellier, France.
¹⁶ Department of Gynaecology, Obstetrics and Reproductive Medicine, Université de Paris Est Créteil, CHIC of Créteil, Créteil, France; INSERM U955 Institut Biomédical Henri Mondor, Créteil, France.
¹⁷ Department of Anaesthesiology and Intensive Care, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France.
¹⁸ Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁹ Department of Anaesthesiology and Intensive Care and SMUR, Lariboisière University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
²⁰ Department of Gynaecology, Obstetrics and Reproductive Biology, Dijon Bourgogne University Hospital, France; UFR Sciences de santé Dijon, Université de Bourgogne, France.
²¹ Department of Anaesthesiology and Intensive Care, Nancy University Hospital, Nancy, France.
²² Division of Obstetrics and Gynaecology, Antoine Béclère University Hospital, Université de Paris Saclay, Assistance Publique-Hôpitaux de Paris, Paris, France.
²³ Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Université de Aix Marseille, France; Centre for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Université de Aix Marseille, Marseille, France.
²⁴ "Grossesse et Santé, Contre la Prééclampsie" Association, Paris, France.
²⁵ Department of Gynaecology and Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University de Paris-Saclay, UVSQ, CESP, INSERM, Villejuif, France.
²⁶ Centre de Recherche Épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France; Department of Gynaecology and Obstetrics, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
²⁷ Department of Obstetrics and Gynecology, Aliénor d'Aquitaine Maternity Hospital, Bordeaux University Hospital, Bordeaux, France.

PMID: 34602381
DOI: 10.1016/j.accpm.2021.100901

Abstract

Objective: To provide national guidelines for the management of women with severe pre-eclampsia.

Design: A consensus committee of 26 experts was formed. A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.

Methods: The last SFAR and CNGOF guidelines on the management of women with severe pre-eclampsia were published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology.

Results: The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1+/-), 9 have a moderate level of evidence (GRADE 2+/-), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations.

Conclusions: There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe pre-eclampsia.

Keywords: Guidelines; Maternal morbidity; Neonatal morbidity; Severe pre-eclampsia.

Publication types

Practice Guideline

MeSH terms

Female
Humans
Infant, Newborn
Pre-Eclampsia* / therapy
Pregnancy