Study of the time of termination of pregnancy and delivery type for patients with severe pre-eclampsia
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Objective:To investigate the proper time of termination of pregnancy and the method of delivery for patients with severe pre-eclampsia.Methods:Total 155 patients with severe pre-eclampsia from 28 to 41 weeks' gestation were admitted,maternal and natal pregnancy outcome were analyzed retrospectively.Results:All mothers were cured and were discharged home,101 cases were terminated by caesarean section(65.16%).No neonatal death happened in mature newborns,there were 14 cases neonatal death in preterm infants,the mortality increased significantly in those newborns less than 34 weeks' gestation and weight lower than 1 500 g.Pregnancy women with different weeks' gestation had no significant difference in the age,blood pressure and delivery type(P0.05),had significant difference in the 24-hour proteinuria(P0.05).There were very significant difference in newborn weight,neonatal asphyxia and neonatal morbility among newborns with different weeks' gestation(P0.01).There were no significant difference in asphyxia and morbility for newborns with different delivery type(P0.05).Conclusion:Pregnancy can be terminated actively in patients with severe pre-eclampsia who has more than 34 weeks' gestation and expected fetus weight more than 1 500 g,caesarean section may be the major method of termination of pregnancy.Cite
Objective : We performed this study to determine the safety and danger of preterm delivery at gestational age 34-36 weeks through antenatal profiles, neonatal conditions, neonatal morbidities. Methods : We reviewed our antenatal and neonatal data between December 1999 and April 2001 to determine the morbidities of infants delivered at gestational age 34-36 weeks using χ2test and Fisher's exact test. Results : 1. Mean age was 30.8±4.58yrs and mean gravida was 2.68±1.56. Preterm premature rupture of membrane was higher in preterm delivery at gestational age 34 and 35weeks(respectively 58.6%, 50%). There was no difference in using tocolytics but, antenatal steroid treatment for prevention of respiratory distress syndrome(RDS) was most frequent in gestational age 34weeks.(20.68%)
2. There was no difference in the risk factor of preterm labor at each group. 3. 1-minute Apgar score<7 was significantly more frequent in neonates at gestational age 34weeks but neonatal weight and meconium staining were not different. 4. The rate of neonatal intensive care unit(NICU) admission was significantly higher in neonates delivered at gestational age 34weeks(93.1%), and RDS occurred in 3 cases delivered at gestational age 34weeks(10.34%). 2 cases delivered at gestational age 34 weeks needed the use of ventilator. Conclusion : Our study shows significant differences in neonatal morbidities between 34weeks and the others. In particular, all cases of Respiratory distress syndrome(n=3) occur in neonates delivered at 34weeks gestation not receiving antenatal steroid treatment and neonatal morbidities at 35 and 36weeks of gestation were not different with full term gestation.
Antenatal steroid
Meconium aspiration syndrome
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A total of 58 women with severe preeclampsia between 28-33 weeks of gestation were studied during the period from 1 October 1996 to 1 October 1997. Twenty-four women (42%) developed maternal or fetal indications necessitating early delivery within 48 hours, meanwhile the other 34 patients (58%) received expectant management. The average pregnancy prolongation period in the conservative management group was 6.4 days (range 3 to 18). The primary indications for delivery in this group were maternal indications 16 (47%), fetal compromise 13 (39%), 34 weeks of gestation 3 (8%), abruption placentae 1 (3%) and preterm labor 1 (3%). The mean birth weight and Apgar score at 5 minutes were 1520 +/- 310 g and 8, respectively. Expectant management was not associated with fetal death or maternal complications. The only neonatal death was related with sepsis and prematurity. The women in the early delivery group totaled two stillbirths and three neonatal deaths.
Placental abruption
Apgar score
Expectant management
Maternal death
Conservative Management
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Summary Delivery was delayed until 34 weeks in 129 patients with severe pre-eclampsia, unless the maternal or fetal conditions necessitated earlier delivery. No patient developed eclampsia although all sedation was terminated from 24 hours after admission until labour started, unless there was a sudden change in the patient's clinical condition. Of the 14 fetuses that died in utero, only 4 weighed more than 1 000 g at delivery. Three of these 4 had already died by the time of the mothers' admission. Abruptio placentae was the cause of 36% of intra-uterine deaths. The perinatal mortality rate was 223/1 000. Survival rates for liveborn babies were 47%, 78% and 82% for birth weights of 750 - 999 g, 1 000 - 1 249 g and 1 250 1 499 g respectively. No neonate died when the birth weight was 1 500 g or more. S Air Med J 1987; 71: 555-558.
Perinatal mortality
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Objective:To investigate the difference of maternal and perinatal outcome with expectant management and gestational age at delivery of pre-eclampsia.Methods:67 cases meeting pre-eclampsia who underwent expectant management were enrolled in this study. Patients were divided into 4 groups: group A (n=6) with onset before 32 weeks of gestation, group B (n=2) with onset during 32-33 weeks of gestation, group C (n=16) with onset during 34-36 weeks of gestation, group D (n=43) with onset ≥37 weeks of gestation. Main outcome measures included prolongation of gestation, perinatal mortality rate and major complication.Results: The average pregnancy prolongation was (46.2±18.2) days, (19.0±7.1) days, (12.2±9.0) days, (5.2±7.8) days, respectively in groups A, B ,C, D. The onset gestational age and the gestational age at delivery was closely associated with the perinatal outcome. Perinatal mortality onsetting before 32 weeks of gestation was significantly higher than that onsetting after 32 weeks of gestation. Major complication morbidity onsetting before 34 weeks of gestation was significantly higher than that onsetting before 34 weeks of gestation. Perinatal mortality before 32 weeks of gestational age at delivery was significantly higher than that after 32 weeks of gestational age at delivery.Conclusion:Perinatal mortality and major complication morbidity are significantly higher than that onsetting after 32 weeks of gestation. Expectant management should be carried out to 32 weeks of gestation even 34 weeks in well-selected patients and should be selected reasonable gestational age at delivery.
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Objective:To investigate the clinical therapy for early-onset severe preeclampsia.Methods:The clinical data of 81 patients with early-onset severe preeclampsia and their 85 neonates were analyzed retrospectively.The cases were divided into three groups according to the onset gestation age.Group A included 9 cases between 24-27+6 weeks,group B 46 cases between 28-31+6weeks and group C 26 cases between 32-34 weeks.The general condition,complication and outcome of both mothers and infants were observed.Results:The gestation age was prolonged about(10.0±3.1)days in group A,(13.7±5.2)days in group B and(12.6±3.5)days in group C,respectively.There were no significant differences in clinical symptoms or complications among the three groups(P0.05).The neonatal asphyxia rate and perinatal infant mortality in the three groups declined with the gestation age.And the differences were statistically significant(P0.05-P0.01).Conclusions:During the expectant treatment,the condition of maternity and fetus should be closely monitored,and pregnancy termination should be decided timely.
Group B
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Objective To analyze the time limit and pregnancy outcome of expectant management for early-onset severe preeclampsia(EOSP).Methods Sixty-six EOSP patients with no severe complications were enrolled and divided into three groups based on gestational weeks before termination of pregnancy: group A,10 cases,onset before 28 weeks of pregnancy;group B,24 cases,28-31+6 weeks of gestation;group C,32 cases,28-31+6 weeks of gestation.Timing of therapy at duration of pregnancy,complications of pregnant women,and fetal and prenatal outcome were analyzed.Results An incidence of complications in the gravida increased with the weeks of gestation in the three groups,with no significant differences among them(P0.05).The rates of fetal distress,fetal death,neonatal asphyxia and neonatal mortality decreased with the increase of gestational weeks,the differences were significant(P=0.000-0.006).The time of expectant treatment for patients in group B was longer than that of groups A(F=7.572;q=7.587;P0.05) and C(q=6.457,P0.05),while the differences were not significant between groups A and C(P0.05).The rate of cesarean section was not significant among the three groups(P0.05).Conclusion Non-surgical therapy is feasible for EOSP under close monitoring to weigh the merits and demerits,and termination of pregnancy to be carried out at the right moment as needed,and Cesarean section is still the main procedure for this condition.
Group B
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Objective To investigate the effect of expectant management on the maternal and/or infant out-comes of early onset severe preeclamp sia in different gestafional weeks. Methods A retrospective study was carried out on 158 patients with early onset severe preeclampsia. They were divided into three groups according to their onset gestation ago:group A( <28weeks,n=28) ,group B(≥28、<32weeks,n=51) and group C(≥32、< 34weeks,n =79). Results The rates of complications declined along with the postponement of the onset gestation age, but there was no statistical significant difference among these three groups. The neonatal asphyxia rate and perinatal infant mor-tality of these three groups declined along with the postponement of gestation age, and there were statistical significant differences among these three groups ( P<0.05 ). Expectant treatment time of group B was significantly longer than that of the other two groups ( P<0.05 ), and cesarean section was a main method of pregnancy termination for the groups B and C. Conclusion The smaller the gestational ages in the early onset severe preeelampsia,the higher the maternal and/ or infant complication rates, neonatal morbidity and mortality.
Key words:
Pre-eclampsia; Asphyxia neonatorum; Infant mortality
Asphyxia Neonatorum
Group B
Perinatal mortality
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Cesarean delivery
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To observe whether the pregnancy can be safely continued for a reasonable period to gain fetal maturity in cases of eclampsia and severe pre-eclampsia.Fifty-one patients were followed up in a specialized care (eclampsia) unit in Dhaka Medical College and Hospital between January 1998 and October 2000. Twenty-one patients with complaints of headache and blurred vision, and 30 patients with history of convulsion, all at gestational age < 36 weeks, were enrolled for this study. Magnesium sulfate was used to prevent convulsion in severe pre-eclampsia and to control convulsion in eclampsia. After conducting a baseline assessment, pregnancy was continued to gain fetal maturity. Patients were monitored closely. Diastolic blood pressure, 24-hour urinary total protein (UTP), and serum uric acid were chosen as the main parameters to detect the deterioration of a patient's condition. Pregnancy was terminated when deterioration occurred, as determined clinically or by 1 or more of the above parameters. Dexamethasone was used during the waiting period for fetal lung maturity. Patient outcomes were analyzed.At admission, the patients' mean gestational age ( SD) was 30.65 2.38 weeks, and the range was 24-34 weeks. Mean diastolic blood pressure was 109.06 11.61 mm Hg, 24-hour UTP was 2.25 1.73 g/24 h, and serum uric acid level was 5.5 1.12 mg/dL. Pregnancy was continued for a mean of 13.27 8.26 days (range, 3-35 days). Thirty-two babies (62.75%) with birth weight 1.0-2.5 kg (2.02 0.45) were born alive. Six of them (18.75%) weighing between 1.0 and 1.5 kg at birth were referred to the intensive care unit, and 1 (3.13%) weighing 1 kg at birth died within 5 minutes after birth. Among live-born babies, 93.75% were in good condition at the time of discharge from the hospital. Intrauterine death occurred in 19 (37.25%).cases. Twelve of them delivered spontaneously within 7 days of death and 7 required induction. In all cases, maternal condition was satisfactory.In carefully selected cases and with close supervision, pregnancy may be continued in women with eclampsia and severe pre-eclampsia to increase fetal maturity without increasing the risk to the mother.
Convulsion
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