{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:44:19Z","timestamp":1787013859569,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T00:00:00Z","timestamp":1598572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>There is little evidence to guide the timing of delivery of women with early\u2010onset severe preeclampsia. We hypothesize that immediate delivery is not inferior for neonatal outcome but reduces maternal complications compared with temporizing management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>\n                      This Dutch multicenter open\u2010label randomized clinical trial investigated non\u2010inferiority for neonatal outcome of temporizing management as compared with immediate delivery (TOTEM NTR\n                      <jats:italic>\u00a0<\/jats:italic>\n                      2986) in women between 27\n                      <jats:sup>+5<\/jats:sup>\n                      and 33\n                      <jats:sup>+5<\/jats:sup>\n                      \u00a0weeks of gestation admitted for early\u2010onset severe preeclampsia with or without HELLP syndrome. In participants allocated to receive immediate delivery, either induction of labor or cesarean section was initiated at least 48\u00a0hours after admission. Primary outcomes were adverse perinatal outcome, defined as a composite of severe respiratory distress syndrome, bronchopulmonary dysplasia, culture proven sepsis, intraventricular hemorrhage grade 3 or worse, periventricular leukomalacia grade 2 or worse, necrotizing enterocolitis stage 2 or worse, and perinatal death. Major maternal complications were secondary outcomes. It was estimated 1130 women needed to be enrolled. Analysis was by intention\u2010to\u2010treat.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The trial was halted after 35\u00a0months because of slow recruitment. Between February 2011 and December 2013, a total of 56 women were randomized to immediate delivery (n\u00a0=\u00a026) or temporizing management (n = 30). Median gestational age at randomization was 30\u00a0weeks. Median prolongation of pregnancy was 2\u00a0days (interquartile range 1\u20103\u00a0days) in the temporizing management group. Mean birthweight was 1435 g after immediate delivery vs 1294 g after temporizing management (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a0.14). The adverse perinatal outcome rate was 55% in the immediate delivery group vs 52% in the temporizing management group (relative risk 1.06; 95% confidence interval 0.67\u20101.70). In both groups there was one neonatal death and no maternal deaths. In the temporizing treatment group, one woman experienced pulmonary edema and one placental abruption. Analyses of only the singleton pregnancies did not result in other outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early termination of the trial precluded any conclusions for the main outcomes. We observed that temporizing management resulted in a modest prolongation of pregnancy without changes in perinatal and maternal outcome. Conducting a randomized study for this important research question did not prove feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.13976","type":"journal-article","created":{"date-parts":[[2020,8,16]],"date-time":"2020-08-16T08:45:40Z","timestamp":1597567540000},"page":"109-118","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Temporizing management vs immediate delivery in early\u2010onset severe preeclampsia between 28 and 34 weeks of gestation (TOTEM study): An open\u2010label randomized controlled trial"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3191-9362","authenticated-orcid":false,"given":"Johannes J.","family":"Duvekot","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Division of Obstetrics and Prenatal Medicine Erasmus MC University Medical Center Rotterdam Rotterdam The 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