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Hypertens Pregnancy. 2000;19(3):249-59.

Fluid management in severe preeclampsia (VESPA): survey of members of ISSHP.

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North Staffordshire Maternity Unit, Academic Department of Obstetrics & Gynaecology, Staffordshire, United Kingdom.



To determine international expert practice of fluid management and monitoring in severe preeclampsia.


The 447 members of the ISSHP (International Society for the Study of Hypertension in Pregnancy) were issued a postal questionnaire to determine their views and practices of fluid management in severe preeclampsia.


One hundred sixty-six (37%) completed questionnaires were received. Responses indicated that there is no consensus regarding most aspects of management of severe preeclamptic patients. In particular, there is no agreement about which fluid type to administer and how to assess circulatory status in these patients. There were also wide variations in the use of plasma volume expansion as a treatment modality. Statistical comparison of the use of Swan-Ganz catheters in "theoretical" and "actual" practice showed highly significant differences (p < 0.001). The majority of respondents were interested in participating in future research.


The results reflect genuine uncertainty generated by a lack of evidence from randomized trials addressing the acute management of severe preeclamptic patients. Even where clinicians are confident "in theory" that a particular form of treatment is the best, they do not appear to have the resources or commitment to match this with "practice." The majority of respondents were very keen to develop the questions raised further in the context of multicenter clinical trials.

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