title: Expectant management of early onset, severe pre-eclampsia: perinatal outcome.
abstract: OBJECTIVE
  To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia.
  
  
  METHODS
  Prospective case series extending over a five-year period.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaceology, Tygerberg Hospital and University of Stellenbosch, South Africa.
authors.forename: D R
authors.initials: DR
authors.lastname: Hall
authors.forename: H J
authors.initials: HJ
authors.lastname: Odendaal
authors.forename: G F
authors.initials: GF
authors.lastname: Kirsten
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: D
authors.initials: D
authors.lastname: Grové
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008750:Methyldopa / Q000627:therapeutic use; D015999:Multivariate Analysis; D009543:Nifedipine / Q000627:therapeutic use; D011224:Prazosin / Q000627:therapeutic use; D011225:Pre-Eclampsia / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D008750:Methyldopa; D009543:Nifedipine; D011224:Prazosin