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

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% less than or equal to 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.