Expectant management of severe pre-eclampsia

Abstract

To evaluate the safety and outcome of women undergoing expectant management of severe pre-eclampsia, we carried out a retrospective study extending over a 1-year period at Guy's & St Thomas's Hospital, London. Fifty-one women were admitted with a diagnosis of severe pre-eclampsia. Main outcome measures were prolongation of gestation, maternal complication and SCBU admission for neonates. The total number of days from admission to delivery varied between 1 and 57 days with a median of 10 days. About 37% of these women stayed for <1 week, 63% > 1 week, 39% > 2 weeks and 10% > 5 weeks. Maternal complications HELLP syndrome (5.8%) and abruption (5.8%). There was no case of eclampsia (0%). Of the babies of these pre-eclamptics, 35.3% were admitted to SCBU; 50% of these had gestational age less than 34 weeks. Of pre-eclamptic women, 58.8% had an emergency section; 30% of these had a failed induction, 52.9% had IOL, of whom 60% had a successful vaginal delivery, 3.9% had an elective section and 2% had a spontaneous onset of labour and delivery. Maternal indication in the form of either complications, worsening symptoms or deteriorating blood results was a reason for termination of pregnancy in 68.6% women; 17.6% were delivered due to both fetal (abnormal CTG) and maternal reasons, whereas only 7.8% had delivery due entirely to fetal reasons.