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Observations of expectant management in severe preeclampsia between 24 to 36 weeks of pregnancy

*, Shyamala Guruvare and *, Pralhad Kushtagi (2008) Observations of expectant management in severe preeclampsia between 24 to 36 weeks of pregnancy. National Neonatal Forum .

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Abstract

Objective: To study the maternal and perinatal outcome of expectant management in severe preeclampsia between 24–34 weeks of gestation. Setting: University medical center Patients and methods: Thirty three (33) women between 24 weeks to 34 weeks of pregnancy with severe preeclampsia were considered for expectant management. The maternal and fetal condition as well as disease progression was monitored by clinical, laboratory and sonographic evaluations. Doses of antihypertensive drugs adjusted and/or other drugs were added. Two doses of intramuscular dexamethasone 12 mg, 12 hours apart were given on inclusion to study. Interval between admission and 'decision to terminate pregnancy' were noted. Observations: Of the 33 cases in the study, 59 per cent were younger than 30 years and the severe preeclampsia was seen between 28 to 34 weeks of pregnancy in 87 per cent of the cases. No predilection for particular gravidity was noted. Blood pressure was beyond 160/110mm Hg in 45% of the women; proteinuria of >5g/24hours was present in 18%; serum uric acid of >5mg/dl was in 39%; liver enzymes were significantly elevated in 15% and abnormal renal function in 6%; Platelet count was rapidly falling in 6% and one woman had count of < 1,00,000/ cc. One fourth of the women had imminent eclampsia when they presented; and 15% had oliguria. Pregnancies could be prolonged by an average of 9 days and the average birthweight was 1238 g (sd 338). Abnormal fetal heart tracings and/or Doppler flow abnormalities were noted in 30%, four cases (12%) had placental abruption and one (3%) spontaneous preterm labor. There were nine (27%) stillbirths; neonatal deaths were six (18%) of the total cases and 25% of the live births. Cesarean delivery rate for the group was 57%. Fifteen neonates (45% of the group) had significant neonatal complications. Prolonged neonatal care for more than 7 days was required for 16 of 24 (66%) newborns. Eighteen of 33 cases (54%) went home with live babies. Acute renal failure (3%) and postpartum eclampsia (3%) were the observed maternal complications and there was no maternal death. Conclusion: Expectant management offered in severe preeclampsia before 34 weeks of gestation for selected patients helped to gain time for fetal maturity and to organize the resources for managing the anticipated complications.

Item Type: Article
Uncontrolled Keywords: Severe Preeclampsia; preterm; expectant management
Subjects: Medicine > KMC Mangalore > Obstetrics & Gynaecology
Depositing User: KMCMLR User
Date Deposited: 27 Feb 2012 10:50
Last Modified: 27 Feb 2012 10:50
URI: http://eprints.manipal.edu/id/eprint/3372

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