DAILY ANTENATAL TESTING IN WOMEN WITH SEVERE PREECLAMPSIA

OBJECTIVE: Our purpose was to determine whether daily antenatal testin g in the expectant management of severe preeclampsia remote from term prevents stillbirth or neonatal compromise at birth. STUDY DESIGN: We reviewed the medical records of 68 women with severe preeclampsia remo te from term who underwent expectant management with daily fetal testi ng until delivery. On admission each patient had reassuring nonstress testing (absence of persistent severe variable or late decelerations), biophysical profile (greater than or equal to 6), and amniotic fluid volume (greater than or equal to 2 cm maximal vertical pocket before 3 2 weeks or amniotic fluid index greater than or equal to 5 after 32 we eks). RESULTS: There were no stillbirths. Twenty-one patients (31%) ha d nonreassuring testing necessitating delivery. Two neonatal deaths oc curred as a result of complications of prematurity. There were no stat istical differences in the cord arterial pH (p = 0.93) or in the 1- an d 5-minute Apgar scores (p = 0.18 and p = 0.88, respectively) between those with normal and abnormal antenatal testing. CONCLUSIONS: Because optimizing neonatal outcome is the only reason to prolong pregnancy i n women with severe preeclampsia, confirmation of fetal well-being is mandatory. Because neither stillbirths nor fetal compromise at birth o ccurred in patients undergoing daily antenatal testing, we recommend d aily testing in patients with severe preeclampsia managed expectantly.