Outcome of expectant line of management in early onset (24-32weeks) pregnancy induced hypertension
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20171952Keywords:
Expectant line, Preeclampsia, Perinatal outcomeAbstract
Background: Preeclampsia is a disease of multiple organ systems that is unique to pregnancy and is often associated with increased risk of maternal-perinatal adverse outcome, especially when it is severe and occurs well before term.
The objective of the study was to study expectant line of management in early onset pregnancy induced hypertension (24-32 weeks) and its maternal and perinatal outcome in relation to preterm delivery, IUD/ Still birth, and early neonatal deaths.
Methods: Total 100 patients presented with early onset pregnancy induced hypertension admitted in Pravara Medical College and Hospital. 50 patient’s pregnancy terminated (Aggressive Group) depending on patients clinical profile and other 50 patients given expectant line of management and pregnancy was prolonged (Expectant Group). Maternal and perinatal outcome was compared between the two groups.
Results: No maternal mortality was seen in both groups.
Perinatal mortality in aggressive line of management was 54% while in expectant line of management perinatal mortality was 30%. Neonatal deaths account for 24% in aggressive group and 10% in expectant group. Fetal survival rate in expectant group was 70% and in aggressive group it was 46%.
Conclusions: Expectant management of severe preeclampsia at 24 to 32 weeks in a tertiary care center is associated with good perinatal outcome with a minimal risk for the mother.
The early use of antihypertensive drugs, optimum timing of delivery and strict fluid balance will help to achieve successful outcome.
References
Sibai BM, Mercer BM, Sciff E. Aggressive vs expectant management of severe preeclampsia at 28 to 32 weeks gestation. A randomized controlled trial. Am J Obstet Gynaeco. 171:818.
Barber D, Xing G, Towner D. Expectant management of severe eclampsia between 24-32 weeks gestation: A ten year review. Abstract No 742. Presented at the 29th Annual Meeting of the Society for Maternal-Fetal Medicine; 2009:26-31.
Hartikainen A, Aliharmi RH. A cohort study of epidemiological associations and outcomes of pregnancies with hypertensive disorders. Hypertension in Pregnancy. 2009;17:31-41.
Stamilio DM, Sehdev HM, Morgan MA, Propert K, Macones GA. Can antenatal clinical and biochemical markers predict the development of severe preeclampsia? Am J Obstet Gynaecol. 2000;182:589-94.
Dekker GA, Sibai BM. Etiology and pathogenesis of preeclampsia: Current concepts. Am J Obstet Gynaecol. 1998;179:1359-75.
Haddad B, Deis S, Goffinet F. Maternal and perinatal outcomes during expectant management of 239 preeclamptic women between 24 and 33 weeks' gestation. Am J Obstet Gynecol. 2004;190(6):1590.
Duckitt, Harrington; BMJ. 2005 Mar;330(7491):565.
Khan H. Peculiar risk factors and complications of pregnancy induced hypertension in a tertiary care hospital of Peshawar, Pakistan Armed Forces Medical Journal, September. 2009;4:2-4.
Sibai BM, Barton JR, Akl S. A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. Am J Obstet Gynecol. 1992;167(1):879.
Pickles CJ, Broughton Pipkin F, Symonds EM. A randomised placebo controlled trial of labetalol in the treatment of mild to moderate pregnancy induced hypertension. Br J Obstet Gynaecol. 1992:99(12):964.
Singh A, Verma R. Choice of antihypertnesive agents in PIH. Obs and Gynae. 2003;7:57-61.
Visser, Wallenberg. Maternal and perinatal outcome of temporizing management in 254 consecutive patients with severe preeclampsia remote from term. Eur J Obstet Gynaecol Reprod Biol. 1995:63(2):147-54.
Pal AK, Saini AS, Dhillon SPS. HELLP Syndrome associated with moderate to severe pre-eclampsia / eclampsia. J Obstet Gyndecol India. 2003;53(2):165-9.
Haddad B, Barton JR, Livingston JC. Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol. 2000;183:444.
Rose J. Maternal and periantal outcome associated with the syndrome of hemolysis, elevated liver enzymes and low platelets in pre-eclampsia / eclampsia. J Obstet Gynecol Ind. 2004;54(2):147-50.
Girija, Devi U, Udaya R. Unusual accompaniments of pregnancy induced hypertension. Journal of Obst and Gynae of India. 2001;51(6):69-70.
Sibai BM. Am J Obstet Gynaecol: 1990;163(3):733-8.
Olah KS, Redman CW, Gee H. Management of severe, early preeclampsia: is conservative management justified Eur J Obstet Gynecol Reprod Biol. 1993;51:175-80.
Sibai BM, El-Nazer A, Gonzalez-Ruiz A. Severe preeclampsia–eclampsia in young primigravid women: Subsequent pregnancy outcome and remote prognosis. Am J Obstet Gynecol. 1986;155:1011.
Moodley J, Koranteng SA. Expectant management of early onset of severe preeclampsia in Durban. S Afr Med. J. 1993:83(8):584-7.
Pattinson RC. Conservative management of severe proteinuric hypertension before 28 weeks gestation. S Afr Med J. 1988;73:516-8.
Odendaal HJ. Frequent fetal heart rate monitoring for early detection of abruptio placentae in severe proteinuric hypertension. S Afr Med J. 1988:74:19-21.
Jenkins SM, Head BB, Hauth JC. Severe preeclampsia at <25 weeks of gestation: Maternal and neonatal outcomes. Am J Obstet Gynecol. 2002;186:790.
Ingrid PM, Senden G, Annemarie GH, Visser W, Eric AP, Christanne JM. Maternal and perinatal outcome of preeclampsia with an onset before 24 weeks gestation: Audit in a tertiary referral center, Eur J Obstet Gynecol Reprod Biol. 2006;128(1):216-21.
Vigil-De Gracia P, Montufar-Rueda C, Ruiz J. Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks' gestation. Eur J Obstet Gynecol Reprod Biol. 2003;107:24.
Hall DR, Odendaal HJ, Steyn DW. Expectant management of severe pre-eclampsia in the mid-trimester. Eur J Obstet Gynecol Reprod Biol. 2001:96(2):168.
Oettle C, Hall D, Roux A. Early onset severe pre-eclampsia: Expectant management at a secondary hospital in close association with a tertiary institution. BJOG Jan. 2005;112:84-8.