Expectant management of early onset, severe pre-eclampsia: maternal outcome.
OBJECTIVE
To evaluate the safety and outcome of women undergoing expectant management of early onset, severe pre-eclampsia.


METHODS
Prospective case series extending over a five-year period.


METHODS
Tygerberg Hospital, a tertiary referral centre.


METHODS
All women (n = 340) presenting with early onset, severe pre-eclampsia, where both the mother and the fetus were otherwise stable.


METHODS
Frequent clinical and biochemical monitoring of maternal status, together with careful blood pressure control, in a high care obstetric ward.


METHODS
Major maternal complications and prolongation of gestation.


RESULTS
Multigravid women constituted 67% of the group. Antenatal biochemistry was reassuring with some expected, but not severe, deteriorations. Twenty-seven percent of women experienced a major complication, but few had poor outcomes. No maternal deaths occurred. Most major complications resolved quickly, necessitating only three admissions (0.8%) to the intensive care unit. One woman required dialysis. Pregnancies were prolonged by a mean (median) number of 11 days (9) before delivery, with more time being gained at earlier gestations. The postpartum inpatient stay (89% < or =7 days, bearing in mind that 82% of women were delivered by caesarean section) was not extended.


CONCLUSIONS
Careful noninvasive management of early onset, severe pre-eclampsia in a tertiary centre can diminish and limit the impact of serious maternal complications. Valuable time to prolong the pregnancy and improve neonatal outcome is thereby gained.
Hall
D R
DR
Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, South Africa.
Odendaal
H J
HJ
Steyn
D W
DW
Grové
D
D
D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004078:Dihydralazine / Q000627:therapeutic use; D005260:Female; D005316:Fetal Distress; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008750:Methyldopa / Q000627:therapeutic use; D008991:Monitoring, Physiologic / Q000379:methods; D009543:Nifedipine / Q000627:therapeutic use; D011224:Prazosin / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D008750:Methyldopa; D008278:Magnesium Sulfate; D009543:Nifedipine; D004078:Dihydralazine; D011224:Prazosin