Expectant management of preterm preeclampsia in Indonesia and the role of steroids

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.