Expectant management of severe preeclampsia in mid-trimester: a hospital based study
Keywords:
Early onset severe pre-eclampsia, Maternal monitoring, Fetal monitoring, Expectant management, Maternal morbidities, Perinatal outcome, Magnesium sulphateAbstract
Background: Objective of current study was to determine the maternal and perinatal outcome of the expectant management of severe preeclampsia between 24 weeks and 34 weeks of gestation.
Methods: Data was collected from the 50 case notes of the mothers who had expectant management of severe preeclampsia. The study period was April 2011-March 2013. Total of 27 women in the year 2011-2012 (April-March) and 23 women in the year 2012-2013 (April-March) were included. Maternal condition was carefully monitored with the help of non-invasive monitors. Fetal condition was monitored by ultrasound and colour Doppler. Number of days as pregnancy prolongation and maternal and perinatal morbidities were calculated and analysed.
Results: The number of days prolonged has been maximum in gestational age of 28-30 weeks, median being 23.5. There is association between higher maternal DBP and appearance of maternal complications (as DBP increases mother is more at risk).
Conclusions: Pregnancies complicated by severe preeclampsia can be managed expectantly in a tertiary care centre of India (low resource country) provided mother and fetus are monitored for their wellbeing.
Metrics
References
Sahin GH, Gulmezoglu AM. Incidence, morbidity and mortality of preeclampsia and eclampsia. In: Sahin GH, Gulmezoglu AM, eds. Postgraduate Training Course in Reproductive Health/Chronic Disease. Geneva: Foundation for Medical Education and Research; 2003: 1-15.
Sibai BM, Spinnato JA, Watson DL, Hill GA, Anderson GD. Pregnancy outcome in 303 cases with severe preeclampsia. Obstet Gynaecol. 1984;64:319-25.
Sibai BM, Mercer BM, Schiff E, Friedman SA. Aggressive versus expectant management of severe preeclampsia at 28 to 32 weeks’ gestation: a randomized controlled trial. Am J Obstet Gynaecol. 1994;171:818-22.
Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynaecol. 2007;196:514, e1-9.
Crowley PA. Antenatal corticosteroid therapy: a meta-analysis of the randomised trial, 1972-1994. Am J Obstet Gynaecol. 1995;173:322-35.
Odendaal HJ, Pattinson RC, Bam R, Grove D, Kotze TJ. Aggressive or expectant management for patients with severe preeclampsia between 28-34 weeks’ gestation: a randomised controlled trial. Obstet Gynaecol. 1990;76:1070-5.
Sibai BM, Taslimi M, Abdella TN, Brooks TF, Spinnato JA, Anderson GD. Maternal and perinatal outcome of conservative management of severe preeclampsia in mid-trimester. Am J Obstet Gynaecol. 1985;152:32-7.
Chari RS, Freidman SA, Schiff E, Frangieh AT, Sibai BM. Is fetal neurologic and physical development accelerated in preeclampsia? Am J Obstet Gynaecol. 1996;174:829-32.
RCOG Green top Guideline. Preeclampsia, 2010. Available at: https://www.rcog.org.uk/guidelines.
Chammas MF, Nguyen TM, Li MA, Nuwayhid BS, Castro LC. Expectant management of severe preterm preeclampsia: is intrauterine growth restriction an indication for immediate delivery? Am J Obstet Gynaecol. 2000;183:853-8.
Hall DR, Odendaal HJ, Steyn DW, Grové D. Expectant management of early onset, severe preeclampsia: maternal outcome. BJOG. 2000;107:1252-7.
Magpie Trial Collaborative Group. Do women with preeclampsia and their babies benefit from Mag sulphate? The Magpie trial: a randomised placebo controlled trial. Lancet. 2002;359:1877-90.
Bernstein IM, Horbar JD, Badger GJ Ohlsson A, Golan A. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. Am J Obstet Gynaecol. 2000;182:198-206.
