Progesterone to Enhance the Efficacy and Success of Expectantly Managed Preterm Severe/Superimposed Preeclampsia

Inclusion Criteria:

• UMMC antepartum patients with preterm PE between 23 0/7ths and 34 0/7ths weeksgestation when initially evaluated

• Willing and able to understand study procedures and to provide informed consent

Exclusion Criteria:

• >33 weeks gestational age or <23 weeks gestation

• Maternal compromise requiring emergent delivery (ongoing placental abruption, DIC,pulmonary edema).

• Fetal compromise requiring emergent delivery (fetal bradycardia, recurrent latefetal heart rate decelerations, minimal to absent fetal heart rate variability).

• Parameters according to current practice guidelines that exclude a patient fromexpectant management include the following:

• Preterm premature rupture of membranes (PPROM) > 34 weeks gestation;

• Platelet count < 100,000/microliter (thrombocytopenia) with evidence of HELLPsyndrome;

• Persistently abnormal hepatic enzyme concentrations (twice or more upper normalvalues);

• Severe fetal growth restriction (ultrasound-estimated fetal weight less than fifthpercentile);

• Severe Oligohydramnios (AFI < 5cm)

• Reversal of end diastolic flow(REDF) in umbilical artery Doppler testing;

• Recurrent (> 2 readings > 30 minutes apart) severe hypertension despiteantihypertensive therapy;

• Eclampsia;

• Pulmonary edema;

• Abruption placentae;

• Nonreassuring fetal status during daily testing (biophysical profile <4/10 and/orrecurrent variable or late decelerations);

• IUFD