The study of maternal outcome of early onset severe pre eclampsia with expectant management

Authors

  • Manjusha Viswanathan Department of Obstetrics and Gynecology, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum- 695607, Kerala, India
  • Suja Daniel Department of Obstetrics and Gynecology, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum- 695607, Kerala, India

Keywords:

Severe pre-eclampsia (SPE), Eclampsia, HELLP syndrome

Abstract

Background: Hypertensive disorders in pregnancy forms one of the deadly triads along with hemorrhage and jaundice which result in maternal death. The present management is termination of pregnancy which causes high neonatal morbidity. Hence the study is done to assess the outcome of prolongation of pregnancy. The aim of this study was to evaluate the safety and outcome of women undergoing expectant management of early onset severe pre eclampsia.

Methods: Prospective case series extending over 1 year in a tertiary care teaching hospital. All women with singleton pregnancy presenting with severe pre eclampsia with gestational age (GA) less than 34 weeks were included in the study. All patients with major maternal or fetal complications were excluded. The included patients were admitted in the intensive care labor ward for non-invasive monitoring of mother. The patients were treated with anti hypertensives, β methasone injection and prophylactic magnesium sulphate when required. They were monitored with regular 4 hrly BP charting, lab investigations and fetal monitoring. The data obtained were expressed as means with standard deviation and median with range. The difference in mean were analysed, the chi-square test was applied to quantitative variables.

Results: In women recruited in the study after expectant management the mean and median number of days gained by women ante partum was 16.7 and 14.2 days respectively. It is seen that most of the complications occurs after 30 weeks of gestation. There was no death reported.

Conclusions: The results of the study showed that it was best to put the women presenting with early onset severe pre eclampsia in expectant management and deliver her after 34 weeks. This was achieved with no increased mortality or morbidity to mother.

References

Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183(1):S1-S22.

ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2002 Jan;99(1):159-67.

Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC. Hypertensive disorders in pregnancy. In: Williams Obstetrics. 21st ed. New York: McGraw-Hill; 2001:567-618.

Hauth JC, Ewell MG, Levine RJ, et al. Pregnancy outcomes in healthy nulliparas who developed hypertension. Calcium for Preeclampsia Study Group. Obstet Gynecol. 2000;95(1):24-287.

Zhang J, Meikle S, Trumble A. Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States. Hypertens Pregnancy. 2003;22(2):203-12.

Catov JM, Ness RB, Kip KE, Olsen J. Risk of early or severe pre-eclampsia related to pre-existing conditions. Int J Epidemiol. 2007;36(2):412-9.

Haddad B, Deis S, Goffinet F, Paniel BJ, Cabrol D, Siba BM. Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks' gestation. Am J Obstet Gynecol. 2004;190(6):1590-5.

Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005;330(7491):565.

Sanders CL, Lucas MJ. Renal disease in pregnancy. Obstet Gynecol Clin North Am. 2001;28(3):593-600.

Jones DC, Hayslett JP: Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med. 1996;335(4):226-32.

Landon MB. Diabetic nephropathy and pregnancy. Clin Obstet Gynecol. 2007;50(4):998-1006.

Mello G, Parretti E, Gensini F et al. Maternal-fetal flow, negative events, and preeclampsia: role of ACE I/D polymorphism. Hypertension. 2003;41(4):932-7.

Dudding T, Heron J, Thakkinstian A, et al. Factor V Leiden is associated with pre-eclampsia but not with fetal growth restriction: a genetic association study and meta-analysis. J Thromb Haemost. 2008;6(11):1869-75.

Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. Eur J Obstet Gynecol Reprod Biol. 2002;101(1):6-14.

Yamada N, Arinami T, Yamakawa-Kobayashi K et al. The 4G/5G polymorphism of the plasminogen activator inhibitor-1 gene is associated with severe preeclampsia. J Hum Genet. 2000;45(3):138-41.

Eskenazi B, Fenster L, Sidney S. A multivariate analysis of risk factors for preeclampsia. JAMA. 1991;266(2):237-41.

Kongnyuy EJ, Nana PN, Fomulu N, Wiysonge SC, Kouam L. Doh AS. Adverse perinatal outcomes of adolescent pregnancies in Cameroon. Matern Child Health J. 2008;12(2):149-54.

Rijhsinghani A, Yankowitz J, Strauss RA, Kuller JA, Patil S, Williamson RA. Risk of preeclampsia in second-trimester triploid pregnancies. Obstet Gynecol. 1997;90(6):884-8.

Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol. 2007;196(5):514.e1-9.

Gupta LM, Gaston L, Chauhan SP. Detection of fetal growth restriction with preterm severe preeclampsia: experience at two tertiary centers. Am J Perinatol. 2008;25(4):247-9.

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 randomized controlled trial. Obstet Gynecol. 1990;76(6):1070-5.

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 Gynecol. 1994;171(3):818-22.

Sibai BM, Akl S, Fairlie F, Moretti M. A protocol for managing severe preeclampsia in the second trimester. Am J Obstet Gynecol. 1990;163(3):733-8.

Hall DR, Odendaal HJ, Steyn DW, Grov D. Expectant management of early onset, severe pre-eclampsia: maternal outcome. BJOG. 2000;107(10):1252-7.

Alexander JM, Bloom SL, McIntire DD, Leveno KJ. Severe preeclampsia and the very low birth weight infant: is induction of labor harmful? Obstet Gynecol. 1999;93(4):485-8.

Nassar AH, Adra AM, Chakhtoura, N, G mez-Marin O, Beydoun S. Severe preeclampsia remote from term: labor induction or elective cesarean delivery? Am J Obstet Gynecol. 1998;179(5):1210-3.

Alanis MC, Robinson CJ, Hulsey TC, Ebeling M, Johnson DD. Early-onset severe preeclampsia: induction of labor vs elective cesarean delivery and neonatal outcomes. Am J Obstet Gynecol. 2008;199(3):262.e1-6.

Pattinson RC, Odendaal HJ, Du Toit R. Conservative management of SPE before 28 weeks of gestation. S Afr Med J. 1988;73:516-8.

Chari RS, Friedman SA, Schiff E. Daily antenatal testing in women with severe pre eclampsia. Am J Obstet Gynecol. 1995:173:1207-10.

Downloads

Published

2016-12-24

Issue

Section

Original Research Articles