Maternal and perinatal outcome of conservative management of severe preeclampsia in midtrimester.

Pregnancies complicated by severe preeclampsia in the second trimester are associated with a high incidence of perinatal morbidity and mortality. One way to possibly improve perinatal outcome in these pregnancies is to attempt to prolong the gestation with conservative management. Reported here the results of conservative management of 60 consecutive patients with severe preeclampsia in the second trimester (18 to 27 weeks' gestation). Although there were no maternal mortalities, the morbidity rate for the 60 patients was very high. Severe maternal complications included abruptio placentae (n = 13), eclampsia (n = 10), coagulopathy (n = 5), renal failure (n = 3), hypertensive encephalopathy (n = 2), intracerebral hemorrhage (n = 1), and ruptured hepatic hematoma (n = 1). In addition, perinatal outcome for these pregnancies was exceptionally poor, with 31 of the 60 pregnancies resulting in a stillborn infant, and 21 resulting in a neonatal death, for a total perinatal mortality rate of 87%. Thus, the results of this retrospective study do not support the use of conservative management for pregnancies complicated by severe preeclampsia in the second trimester.