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 weeks gestation 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 late fetal heart rate decelerations, minimal to absent fetal heart rate variability).
• Parameters according to current practice guidelines that exclude a patient from expectant management include the following:
• Preterm premature rupture of membranes (PPROM) \> 34 weeks gestation;
• Platelet count \< 100,000/microliter (thrombocytopenia) with evidence of HELLP syndrome;
• Persistently abnormal hepatic enzyme concentrations (twice or more upper normal values);
• Severe fetal growth restriction (ultrasound-estimated fetal weight less than fifth percentile);
• Severe Oligohydramnios (AFI \< 5cm)
• Reversal of end diastolic flow(REDF) in umbilical artery Doppler testing;
• Recurrent (\> 2 readings \> 30 minutes apart) severe hypertension despite antihypertensive therapy;
• Eclampsia;
• Pulmonary edema;
• Abruption placentae;
• Nonreassuring fetal status during daily testing (biophysical profile \<4/10 and/or recurrent variable or late decelerations);
• IUFD