Conservative management of eclampsia and severe pre-eclampsia - A Bangladesh experience

Objective: To observe whether the pregnancy can be safely continued for a reasonable period to gain fetal maturity in cases of eclampsia and severe pre-eclampsia. Methods: Fifty-one patients were followed up in a specialized care (eclampsia) unit in Dhaka Medical College and Hospital between January 1998 and October 2000. Twenty-one patients with complaints of headache and blurred vision, and 30 patients with history of convulsion, all at gestational age < 36 weeks, were enrolled for this study. Magnesium sulfate was used to prevent convulsion in severe pre-eclampsia and to control convulsion in eclampsia. After conducting a baseline assessment, pregnancy was continued to gain fetal maturity. Patients were monitored closely. Diastolic blood pressure, 24-hour urinary total protein (UTP), and serum uric acid were chosen as the main parameters to detect the deterioration of a patient's condition. Pregnancy was terminated when deterioration occurred, as determined clinically or by 1 or more of the above parameters. Dexamethasone was used during the waiting period for fetal lung maturity. Patient outcomes were analyzed. Results: At admission, the patients' mean gestational age (+/- SD) was 30.65 +/- 2.38 weeks, and the range was 24-34 weeks. Mean diastolic blood pressure was 109.06 +/- 11.61 mm Hg, 24-hour UTP was 2.25 +/- 1.73 g/24 h, and serum uric acid level was 5.5 +/- 1.12 mg/dL. Pregnancy was continued for a mean of 13.27 +/- 8.26 days (range, 3-35 days). Thirty-two babies (62.75%) with birth weight 1.0-2.5 kg (2.02 +/- 0.45) were born alive. Six of them (18.75%) weighing between 1.0 and 1.5 kg at birth were referred to the intensive care unit, and 1 (3.13%) weighing 1 kg at birth died within 5 minutes after birth. Among live-born babies, 93.75% were in good condition at the time of discharge from the hospital. Intrauterine death occurred in 19 (37.25%).cases. Twelve of them delivered spontaneously within 7 days of death and 7 required induction. In all cases, maternal condition was satisfactory. Conclusion: In carefully selected cases and with close supervision, pregnancy may be continued in women with eclampsia and severe pre-eclampsia to increase fetal maturity without increasing the risk to the mother.