Expectant management of early onset, severe pre-eclampsia: Perinatal outcome

Objective To evaluate the perinatal outcome of expectant management of earl y onset, severe pre-eclampsia. Design Prospective case series extending over a five-year period. Setting Tertiary referral centre. Population All women (n = 340) presenting with early onset, severe pre-ecla mpsia, where both mother and the fetus were otherwise stable. Methods Frequent clinical and biochemical monitoring of maternal status wit h careful blood pressure control. Fetal surveillance included six-hourly he art rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward. Main outcome measures Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications. Results A mean of 11 days were gained by expectant management. The perinata l mortality rate was 24/1000 (greater than or equal to 1000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestatio nal age at delivery to be significantly associated with neonatal outcome. C hief contributors to neonatal mortality and morbidity were pulmonary compli cations and sepsis. Three pregnancies (0.8%) were terminated prior to viabi lity and only two (0.5%) intrauterine deaths occurred, both due to placenta l abruption. Most women (81.5%) were delivered by caesarean section with fe tal distress the most common reason for delivery. Neonatal intensive care w as necessary in 40.7% of cases, with these babies staying a median of six d ays in intensive care. Conclusion Expectant management of early onset, severe pre-eclampsia and ca reful neonatal care led to high perinatal and neonatal survival rates. It a lso allowed the judicious use of neonatal intensive care facilities. Neonat al sepsis remains a cause for concern.