D R Hall1, H J Odendaal, D W Steyn, D Grové. 1. Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, South Africa.
Abstract
OBJECTIVE: To evaluate the safety and outcome of women undergoing expectant management of early onset, severe pre-eclampsia. DESIGN: Prospective case series extending over a five-year period. SETTING: Tygerberg Hospital, a tertiary referral centre. POPULATION: All women (n = 340) presenting with early onset, severe pre-eclampsia, where both the mother and the fetus were otherwise stable. METHODS: Frequent clinical and biochemical monitoring of maternal status, together with careful blood pressure control, in a high care obstetric ward. MAIN OUTCOME MEASURES: Major maternal complications and prolongation of gestation. RESULTS: Multigravid women constituted 67% of the group. Antenatal biochemistry was reassuring with some expected, but not severe, deteriorations. Twenty-seven percent of women experienced a major complication, but few had poor outcomes. No maternal deaths occurred. Most major complications resolved quickly, necessitating only three admissions (0.8%) to the intensive care unit. One woman required dialysis. Pregnancies were prolonged by a mean (median) number of 11 days (9) before delivery, with more time being gained at earlier gestations. The postpartum inpatient stay (89% < or =7 days, bearing in mind that 82% of women were delivered by caesarean section) was not extended. CONCLUSION: Careful noninvasive management of early onset, severe pre-eclampsia in a tertiary centre can diminish and limit the impact of serious maternal complications. Valuable time to prolong the pregnancy and improve neonatal outcome is thereby gained.
OBJECTIVE: To evaluate the safety and outcome of women undergoing expectant management of early onset, severe pre-eclampsia. DESIGN: Prospective case series extending over a five-year period. SETTING: Tygerberg Hospital, a tertiary referral centre. POPULATION: All women (n = 340) presenting with early onset, severe pre-eclampsia, where both the mother and the fetus were otherwise stable. METHODS: Frequent clinical and biochemical monitoring of maternal status, together with careful blood pressure control, in a high care obstetric ward. MAIN OUTCOME MEASURES: Major maternal complications and prolongation of gestation. RESULTS: Multigravid women constituted 67% of the group. Antenatal biochemistry was reassuring with some expected, but not severe, deteriorations. Twenty-seven percent of women experienced a major complication, but few had poor outcomes. No maternal deaths occurred. Most major complications resolved quickly, necessitating only three admissions (0.8%) to the intensive care unit. One woman required dialysis. Pregnancies were prolonged by a mean (median) number of 11 days (9) before delivery, with more time being gained at earlier gestations. The postpartum inpatient stay (89% < or =7 days, bearing in mind that 82% of women were delivered by caesarean section) was not extended. CONCLUSION: Careful noninvasive management of early onset, severe pre-eclampsia in a tertiary centre can diminish and limit the impact of serious maternal complications. Valuable time to prolong the pregnancy and improve neonatal outcome is thereby gained.
Authors: Arif Aktuğ Ertekin; Bilge Kapudere; Meryem Kurek Eken; Gülşah İlhan; Şükriye Dırman; Mehmet Akif Sargın; Engin Deniz; Güner Karatekin; Ebru Çöğendez; Murat Api Journal: Int J Clin Exp Med Date: 2015-10-15
Authors: Kartik K Venkatesh; Robert A Strauss; Daniel J Westreich; John M Thorp; David M Stamilio; Katherine L Grantz Journal: Pregnancy Hypertens Date: 2020-03-10 Impact factor: 2.899
Authors: Catherine A Cluver; Susan P Walker; Ben W Mol; Gerard B Theron; David R Hall; Richard Hiscock; N Hannan; S Tong Journal: BMJ Open Date: 2015-10-28 Impact factor: 2.692