Maternal and perinatal outcome of women with early‐onset severe pre‐eclampsia before 28 weeks: Is expectant management beneficial in a low‐resource country? A prospective observational study

Abstract

Objective To study the maternal and perinatal outcomes in women with severe pre‐eclampsia before 28 weeks of pregnancy. Methods A descriptive study from a tertiary care center. All consecutive women with severe pre‐eclampsia withonset before 28 weeks of pregnancy were included. The details were collected in a predesigned structured proforma prospectively. Results The study cohort included 145 women with a mean maternal age of 26.97 ± 5.36 years (range 19–47 years). The mean duration of prolongation of pregnancy was 13.04 ± 10.57 days (range 1–51 days). A total of 29.7% (n = 43) of women had at least one major adverse maternal outcome, and the most common was HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome (n = 24,16.6%), followed by eclampsia (n = 12,8.3%). The stillbirth rate was high (n = 103,68.7%), and most occurred in the antepartum period. Of 47 (31.3%) neonates born alive, only eight (17.02%;8/47) survived up to 28 days of life. Fetal growth restriction with Doppler abnormalities and neonatal sepsis were the most common reasons for perinatal mortality. Conclusion Expectant management should not be considered routinely when the onset of severe pre‐eclampsia is before 25+6 weeks of pregnancy. Between 26 and 27+6 weeks it can be offered under close monitoring and the perinatal survival depends on the neonatal services available in their facility.

Pre‐eclampsia in low and middle‐income settings: What are the barriers to improving perinatal outcomes and evidence‐based recommendations?

“…Despite all the debate on this topic, in the context of LMICs, it can be even more complex, considering variables such as geographic distance between a primary health unit and a structured health service with a neonatal intensive care unit, the cut‐off of perinatal survival in LMIC units, availability of structured health services, and the overcrowding of these services and their neonatal intensive care units, as well as recognizing pre‐eclampsia cases that need to be referred to these centers. These circumstances lead to unpredictable clinical progression in the setting of pre‐eclampsia with signs of severity 19 …”

“…These circumstances lead to unpredictable clinical progression in the setting of pre-eclampsia with signs of severity. 19…”