Dear Editor,
We thank Leite T. and Paravidino V. B. for the interest and thoughtful comments, and
we agree that the topic of this article is of great clinical relevance.[1] We acknowledge the concern about methodological issues, such as time period and
search strategy; and we hope to further clarify the approach used. The review was
supported by the National Brazilian Specialized Committee on Preeclampsia of the Brazilian
Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese
acronym), aiming to enable national awareness regarding the most important cause of
maternal mortality and morbidity in our scenario. This group of specialists revised
the presented results and sought to ensure a simple and clear text and method, mostly
for an audience of clinicians.
The decision of considering the restricted period (between 2014 and 2017) was mainly
due to two reasons. The first one was to reflect the new recommendations adopted by
the International Society for the Study of Hypertension in Pregnancy (ISSHP), which
has broadened the definition of preeclampsia after 2013.[2] Since then, preeclampsia is diagnosed not only if there is a new onset of hypertension
and proteinuria, but also if hypertension and significant end-organ dysfunction without
proteinuria occur after 20 weeks of gestation. The second reason was to consider a
period after which there was a similar Cochrane review.[3] A systematic review is a method to synthesize the available evidence using an explicit,
transparent approach, and this was indeed performed.
The present review aimed to update the available evidence on the best timing of delivery
for preterm preeclampsia. We do understand all the requirements on the Cochrane Handbook
for Systematic Reviews and also acknowledge previous published reviews on the topic
by the Cochrane initiative.[3]
[4] However, the 2013 Cochrane review[3] considered preeclampsia cases between 24 and 34 weeks of gestation, and the 2017
Cochrane review considered cases between 34 weeks of gestation and term pregnancy.[4] We have decided to consider both, before and after 34 weeks of gestation, and to
present results in a comprehensive way, to guide counseling. This is why we even included
a box that presented “How to talk with pregnant mothers and their families about the
risks, benefits and uncertainties of immediate delivery versus expectant management
when preterm preeclampsia is diagnosed.”
The other key concern about the search strategy is also very relevant. We did initially
use many other Medical Subject Headings (MeSh) terms, but chose the simplest combination
of terms, with no loss of retrieved articles. To make sure this was true, we have
now performed again the same search using the suggested terms and have retrieved the
exact same final papers. The same happened with the databases. We should have stated
that Lilacs and Embase were searched, but we again chose to present the most straightforward
approach.
It is clear from the thoughtful comments presented that there are still unanswered
questions on this topic, and we hope to stimulate future studies to guarantee adequate
patient care and counseling in cases of preterm preeclampsia. We invite the comment
authors to join forces in future researches and reviews on the topic.
