OBJECTIVE: To evaluate the perinatal outcome of expectant management of early 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-eclampsia, where both mother and the fetus were otherwise stable. METHODS: Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart 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 perinatal mortality rate was 24/1,000 (> or = 1,000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care. CONCLUSION: Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern.
OBJECTIVE: To evaluate the perinatal outcome of expectant management of early 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-eclampsia, where both mother and the fetus were otherwise stable. METHODS: Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart 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 perinatal mortality rate was 24/1,000 (> or = 1,000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care. CONCLUSION: Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern.
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: Luiza O Perucci; Fernanda S Carneiro; Cláudia N Ferreira; Michelle A Sugimoto; Frederico M Soriani; Gustavo G Martins; Kátia M Lima; Flávia L Guimarães; Antônio L Teixeira; Luci M Dusse; Karina B Gomes; Lirlândia P Sousa Journal: PLoS One Date: 2015-09-23 Impact factor: 3.240
Authors: Mi Jung Kim; Young Nam Kim; Eun Jung Jung; Hye Ree Jang; Jung Mi Byun; Dae Hoon Jeong; Moon Su Sung; Kyung Bok Lee; Ki Tae Kim Journal: Obstet Gynecol Sci Date: 2017-05-15
Authors: A Perales; J L Delgado; M de la Calle; J A García-Hernández; A I Escudero; J M Campillos; M D Sarabia; B Laíz; M Duque; M Navarro; P Calmarza; M Hund; F V Álvarez Journal: Ultrasound Obstet Gynecol Date: 2017-09 Impact factor: 7.299