Expectant management of early onset, severe
pre-eclampsia: perinatal outcome.
-
Hall DR,
Odendaal HJ,
Kirsten GF,
Smith J,
Grove D.
Department
of Obstetrics and Gynaceology, Tygerberg Hospital and University of
Stellenbosch, South Africa.
Objectives:
To evaluate the perinatal outcome of expectant management of early onset,
severe pre-eclampsia.
Design:
Prospective case series extending over a
five-year period.
Setting:
Tertiary referral centre.
POPULATION:
All women (n = 340) presenting with early onset, severe pre-eclampsia, where
both mother and the fetus were otherwise stable.
Methods:
Frequent clinical and biochemical monitoring of maternal status with careful
blood pressure control. Fetal surveillance included six-hourly heart rate
monitoring, weekly Doppler and ultrasound evaluation of the fetus every two
weeks. All examinations were carried out in a high care obstetric ward.
MAIN
OUTCOME MEASURES: Prolongation of gestation, perinatal mortality rate,
neonatal survival and major complications.
Results:
A
mean of 11 days were gained by expectant management. The perinatal mortality
rate was 24/1,000 (> or = 1,000 g/7 days) with a neonatal survival rate of
94%. Multivariate analysis showed only gestational age at delivery to be
significantly associated with neonatal outcome. Chief contributors to
neonatal mortality and morbidity were pulmonary complications and sepsis.
Three pregnancies (0.8%) were terminated prior to viability and only two
(0.5%) intrauterine deaths occurred, both due to placental abruption. Most
women (81.5%) were delivered by caesarean section with fetal distress the
most common reason for delivery. Neonatal intensive care was necessary in
40.7% of cases, with these babies staying a median of six days in intensive
care.
Conclusion:
Expectant management of early onset, severe pre-eclampsia and careful
neonatal care led to high perinatal and neonatal survival rates. It also
allowed the judicious use of neonatal intensive care facilities. Neonatal
sepsis remains a cause for concern.
