MATERNAL AND PERINATAL OUTCOME OF TEMPORIZING MANAGEMENT IN 254 CONSECUTIVE PATIENTS WITH SEVERE PREECLAMPSIA REMOTE FROM TERM

Objective: To assess maternal and perinatal outcomes of expectant mana gement with plasma volume expansion and pharmacologic vasodilatation i n patients with severe pre-eclampsia remote from term. Study design: A ll women with severe pre-eclampsia between 20 and 32 weeks' gestation, not in labor and with a live, single fetus admitted to the University Hospital Rotterdam from 1985 to 1993 were managed with the intention to prolong gestation. Treatment consisted of correction of the materna l circulation with vasodilatation by means of dihydralazine and plasma volume expansion under central hemodynamic monitoring. Primary end-po ints of the study were prolongation of gestation, maternal antepartum and postpartum complications, and fetal and neonatal outcome. Results: Two-hundred fifty-four patients were included. The median prolongatio n of pregnancy was 14 (range 0-62) days. Hemodynamic treatment was ass ociated with marked objective and subjective improvement in maternal c ondition. Complications of central hemodynamic monitoring were not obs erved. Perinatal mortality was 20.5%. Conclusion: Expectant management with plasma volume expansion and pharmacologic vasodilatation under c entral hemodynamic monitoring of the maternal circulation may delay de livery and enhance fetal maturity and does not appear to be associated with an increased risk of maternal morbidity and mortality.