Introduction of management protocol for early-onset severe pre-eclampsia.
OBJECTIVE
This quality Improvement study evaluated the applicability of our protocol for early-onset severe pre-eclampsia, prepared in April 2013.


METHODS
We collected data from all women with early-onset severe pre-eclampsia treated at our hospital between March 2008 and August 2015. Neonatal and maternal outcomes were compared between protocol-based (n = 17) and non-protocol-based management groups (n = 28).


RESULTS
The latency period was significantly longer in the protocol-based than in the non-protocol-based group (21.9 ± 3.7 vs 11.0 ± 2.9 days). Gestational age at delivery was significantly more advanced in the protocol-based than in the non-protocol-based group (31.4 ± 0.6 vs 29.8 ± 0.4 weeks). Serious neonatal complications were significantly less prevalent in the protocol-based than in the non-protocol-based group (26% vs 79%). Among the protocol components, magnesium sulfate use was the only independent factor contributing to the absence of serious neonatal complications. The percentages of women exhibiting persistent proteinuria or hypertension at one, two and three months post-partum were similar between the groups.


CONCLUSIONS
Strict adherence to our protocol improved neonatal outcomes without affecting maternal prognosis. Routine use of magnesium sulfate could be the most important component of the protocol.
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Chieko
C
Sakae
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Yukiyasu
Y
Sato
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Shota
S
Kanbayashi
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Atsuko
A
Taga
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Ikuko
I
Emoto
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Shunsuke
S
Maruyama
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Hiroko
H
Mise
Department of Obstetrics and Gynecology, Otsu Red Cross Hospital, Otsu, Japan.
Tomoko
T
Kim
D000328:Adult; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008278:Magnesium Sulfate / Q000494:pharmacology*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D058996:Quality Improvement / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D015149:Tocolytic Agents / Q000494:pharmacology*; D055815:Young Adult
D015149:Tocolytic Agents; D008278:Magnesium Sulfate
Doppler-diagnostic; fetal growth assessment; pre-eclampsia/eclampsia; renal and hypertension