Ernawati and Erliana and Agus Sulistyono and Hermanto Tri Joewono and Muhammad Ilham Aldika Akbar and Budi Wicaksono and Khanisyah Erza Gumilar and Manggala Pasca Wardhana and Nareswari Cininta and Rozi Aditya Aryananda and Risa Etika and Windu Purnomo and Nadhir Abdullah and Erry Gumilar Dachlan and Gustaaf Dekker and Aditiawarman (2018) Expectant management of severe preeclampsia in a developing country: Maternal outcomes and perinatal survival. ScenceDirect.

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Abstract

Background Management of severe preeclampsia which develops prior to 34 still debatable. Immediate delivery leads to high neonatal mortality and morbidity due to prematurity, conversely expectant management may potentially increase maternal morbidity and mortality. Objective of this study was to determine maternal outcomes and perinatal survival achieved with expectant management in patients presenting with preeclampsia <34 weeks. Study Design A retrospective cohort analysis of outcome in patients with severe preeclampsia in a tertiary hospital in Indonesia during 3 years: 165 patients (178 fetuses) managed expectantly were studied. Neonatal outcomes (birth weight, APGAR score, fetal growth restriction (FGR), intrauterine fetal death (IUFD), early neonatal death, and maternal complications (HELLP syndrome, pulmonary edema, eclampsia, renal insufficiency, and placental abruption) were registered. Results 25 patients had a preeclampsia disease onset <28 weeks, 72 patients onset 28 0/7–30 6/7 weeks and 68 patients onset 31 0/7 −33 6/7 weeks; 13 patients had twins. Mean days of prolongation was 9.3 days (range 2–64). Overall neonatal survival was 64,6%. Mean birth weight was 1323.08 ± 383.55 gram, 23,59% of the neonates had a birth weight <10th centile. IUFD ocured in 7.9% of pregnancies, and 25.3% of the remaining babies died during early neonatal period. There were no neonatal survivors in those with a GA <26 weeks. At 26 to 27 6/7 weeks GA, 38.5% offspring survived. Regarding maternal outcome, 7.3% of the patients developed pulmonary edema, 5.5% HELLP syndrome, 0.6% renal insufficiency and 0.6% placental abruption. In this patient cohort, none of the patients developed eclampsia, whereas one patient died post-partum due to stroke emboli. Conclusion Neonatal outcome in preterm severe preeclampsia depends mainly on GA at onset of preeclampsia and GA at delivery. Expectant management of preeclampsia presenting at less <28 weeks is not recommended in a developing country with limited neonatal resources.

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