Expectant management of early onset, severe pre‐eclampsia: maternal outcome

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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%≤ 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.

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