Expectant management of early onset, severe pre-eclampsia: perinatal outcome.
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.
Hall
D R
DR
Department of Obstetrics and Gynaceology, Tygerberg Hospital and University of Stellenbosch, South Africa.
Odendaal
H J
HJ
Kirsten
G F
GF
Smith
J
J
Grové
D
D
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
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D008750:Methyldopa; D009543:Nifedipine; D011224:Prazosin