Expectant Management of Severe Pre-eclampsia remote from term: Maternal and Perinatal outcome

Background: Management of severe pre eclampsia remote from term remains one of the most difficult challenges in obstetric practice. Expectant management of early onset severe pre eclampsia improves neonatal outcome. Methods: A prospective case series extending over five years peiod were recorded to evaluate the maternal and perinatal outcome of expectant management of severe preeclampsia presenting between 24-34 weeks of gestation in a tertiary referral center. All women (n=160) presenting with early onset (24-34 weeks of gestation) severe preeclampsia , where both the mother and the fetus were otherwise stable. Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Foetal surveillance included six hourly foetal heart rate monitoring, bi weekly non stress test and weekly USG evaluation. Results: Mean number of days of prolongation of gestation was 6 days ( range 1-24days). The largest prolongation of pregnancy was recorded in patients with the lowest gestational age. Conservative management was associated with a 1.63% ( 17/160) intrauterine fetal loss rate. The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at <30 weeks. Increasing gestational age correlated with a reduction of RDS ( respiratory distress syndrome). Maternal morbidities were significantly higher among those managed at < 32 weeks. But there was no maternal mortality. Conclusion: Good perinatal outcome and less risk to mother can be achieved at 30-34 weeks gestation. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 73-78

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Management of early onset severe preeclampsia in a tertiary hospital in india: does expectant management alter perinatal outcome?

Indian Journal of Medical Sciences ◽

10.4103/0019-5359.109903 ◽

2011 ◽

Vol 65 (12) ◽

pp. 535 ◽

Cited By ~ 2

Author(s):

Manisha Kumar ◽

Usha Gupta ◽

Namita Jain ◽

Jyoti Meena ◽

Abha Singh

Keyword(s):

Early Onset ◽

Perinatal Outcome ◽

Expectant Management ◽

Tertiary Hospital ◽

Severe Preeclampsia

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Neonatal Survivability following Previable PPROM after Hospital Readmission for Intervention

American Journal of Perinatology Reports ◽

10.1055/s-0040-1721421 ◽

2020 ◽

Vol 10 (04) ◽

pp. e395-e402

Author(s):

Felicia LeMoine ◽

Robert C. Moore ◽

Andrew Chapple ◽

Ferney A. Moore ◽

Elizabeth Sutton

Keyword(s):

Gestational Age ◽

Neonatal Intensive Care ◽

Intensive Care Unit Discharge ◽

Expectant Management ◽

Antibiotic Administration ◽

Tertiary Referral Center ◽

Membrane Rupture ◽

South Central ◽

Prelabor Rupture Of Membranes ◽

Latency Duration

Abstract Objective To describe our hospital's experience following expectant management of previable preterm prelabor rupture of membranes (pPPROM). Study Design Retrospective review of neonatal survival and maternal and neonatal outcomes of pPPROM cases between 2012 and 2019 at a tertiary referral center in South Central Louisiana. Regression analyses were performed to identify predictors of neonatal survival. Results Of 81 cases of pPPROM prior to 23 weeks gestational age (WGA), 23 survived to neonatal intensive care unit discharge (28.3%) with gestational age at rupture ranging from 180/7 to 226/7 WGA. Increased latency (adjusted odds ratio [aOR] = 1.30, 95% confidence interval [CI] = 1.11, 1.52) and increased gestational age at rupture (aOR = 1.62, 95% CI = 1.19, 2.21) increased the probability of neonatal survival. Antibiotics prior to delivery were associated with increased latency duration (adjusted hazard ratio = 0.55, 95% CI = 0.42, 0.74). Conclusion Neonatal survival rate following pPPROM was 28.3%. Later gestational age at membrane rupture and increased latency periods are associated with increased neonatal survivability. Antibiotic administration following pPPROM increased latency duration.

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466: Expectant management of severe preeclampsia at 27 0/7- 33 6/7 weeks gestation: Maternal and perinatal outcomes according to gestational age at onset

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2007.10.485 ◽

2007 ◽

Vol 197 (6) ◽

pp. S137

Author(s):

Annette Bombrys ◽

John R. Barton ◽

Mounira Habli ◽

Elizabeth Nowacki ◽

Helen How ◽

...

Keyword(s):

Gestational Age ◽

Age At Onset ◽

Perinatal Outcomes ◽

Expectant Management ◽

Severe Preeclampsia

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Maternal and Neonatal Outcomes in Expectant Management of Early-Onset Severe Preeclampsia

Avicenna Journal of Clinical Medicine ◽

10.52547/ajcm.28.1.28 ◽

2021 ◽

Vol 28 (1) ◽

pp. 28-35

Author(s):

Zohreh Tabasi ◽

Elahe Mesdaghinia ◽

Masoumeh Abedzadeh-Kalahroudi ◽

Hossein Akbari ◽

Mahsa Bandagi-Motlagh ◽

...

Keyword(s):

Early Onset ◽

Expectant Management ◽

Severe Preeclampsia ◽

Neonatal Outcomes ◽

Maternal And Neonatal Outcomes

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Foetal umbilical artery doppler versus NST as predictors of adverse perinatal outcome in severe preeclampsia and foetal growth restriction

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171977 ◽

2017 ◽

Vol 6 (5) ◽

pp. 2060

Author(s):

Amandeep Raj ◽

Reema Kumar Bhat ◽

S. Prajwal ◽

Rao P. S.

Keyword(s):

Mortality Rate ◽

Diagnostic Accuracy ◽

Complication Rate ◽

Perinatal Outcome ◽

Color Doppler ◽

Stress Test ◽

Severe Preeclampsia ◽

Adverse Perinatal Outcome ◽

Foetal Growth ◽

Foetal Growth Restriction

Background: With the advent of electronic foetal monitoring, a relationship between foetal movement and foetal heart rate was observed and that relationship formed the basis for non-stress test (NST). Doppler USG plays an important role in foetal growth restriction (FGR) pregnancies where hemodynamic rearrangements occur in response to foetal hypoxemia. It is now proved that significant Doppler changes occur with reduction in foetal growth at a time when other foetal well-being tests are still normal. This study was done to find out the comparative usefulness of Doppler and NST in the management of FGR and severe preeclampsia and subsequent correlation with perinatal outcome.Methods: This prospective study was conducted on pregnant women with severe preeclamsia and/or FGR beyond 30 weeks of gestation at AHRR Delhi. 50 pregnancies complicated with severe preeclampsia and/or FGR beyond 30 weeks of gestation were selected. Patients meeting the inclusion criteria were subjected to NST. Umbilical arterial Doppler flow was obtained at weekly or twice weekly interval depending on the severity by pulsed wave color doppler indices were measured during foetal apnea by the same examiner at the free loop site where the clearest waveform signal could be visualized. Of 3 measurements, the mean average of S/D ratio was recorded and followed up with serial Doppler assessment and non-stress test. Data was collected and statistical analysis was carried out.Results: The Doppler showed changes earlier than NST giving a significant lead time of up to 20 days with an average of 4.94 days. The UA S/D had the highest sensitivity (88%) and diagnostic accuracy (94%) in predicting the adverse perinatal outcome. The sensitivity and specificity of Doppler as compared to NST was 82.6% and 63.0% respectively with a diagnostic accuracy of 72%. The Doppler has negative predictive value of 80.95% and positive predictive value of 65.5%. Color Doppler has diagnostic accuracy of 72%. The mortality rate in reversal of diastolic flow was 77.77% and in absent UA flow was 16.66%. 12% foetuses were found to have AEDV in UA and among them 66.66% had both FGR+PE as maternal complication. There was 83.33% rate of LSCS, 16.66% neonatal mortality rate, 83.33% NICU stay rate and 66.66% complication rate in neonates. Whereas 18% had REDV and among that 88.88% had both FGR+PE as maternal complication, a similar rate of LSCS, 77.77% rate of neonatal mortality, 100 % NICU stay and 66.66% complication rate in the neonates.Conclusions: Combined foetal testing modalities such as Doppler, NST and biophysical profile provide a wealth of information regarding foetal health. Integrated foetal testing would be ideal for individualized care of the preterm compromised foetuses for timed intervention.

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Elective induction of labour at 39 weeks versus expectant management up to 41 weeks in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20200379 ◽

2020 ◽

Vol 9 (2) ◽

pp. 794

Author(s):

Yogindra M. Kabadi ◽

Sanjana Kumar

Keyword(s):

Cesarean Section ◽

Gestational Age ◽

Perinatal Outcome ◽

Tertiary Care ◽

Expectant Management ◽

Induction Of Labour ◽

Labour Induction ◽

Perinatal Deaths ◽

Elective Induction ◽

Singleton Pregnancies

Background: The timing of delivery and effective management of labour at term makes a huge difference in the obstetric and perinatal outcome. There have always been controversies between choosing the elective induction of labour at 39 weeks versus expectant management up to 41/42 weeks which can result in placental ageing, reduced liquor, non-assuring fetal heart tracings, meconium stained amniotic fluid and fetal macrosomia. our objective was to perform a comparative effectiveness analysis of elective induction of labor at 39 weeks gestational age among nulliparous women with uncomplicated singleton pregnancies as compared to expectant management up to 41 weeks.Methods: 120 primigravidae with singleton pregnancies with fetus in cephalic presentation were recruited into the study and divided into 2 groups of 60 each A: Patients were induced electively using dinoprostone gel (maximum 3 doses 8 hours apart) B: They were managed expectantly up to 41 weeks allowing for spontaneous onset of labour, induction or cesarean section was done for obstetric indications between 39 and 41 weeks and pregnancy was terminated by induction for those who continued up to 41 weeks. Their obstetric and perinatal outcome were noted.Results: The cesarean section rates were higher in the expectantly managed group (21%) when compared to the electively induced group (16%). The same was with instrumental delivery rates (15% versus 10%). The perinatal outcome was poorer for the expectantly managed group with 20% NICU admissions and 5% perinatal deaths compared to the electively induced group which had 12% NICU admissions and 3.3% perinatal deaths. The expectantly managed group also resulted in respiratory distress in a larger number of fetuses and resulted in problems due to reduced liquor.Conclusions: Elective induction at 39 weeks gestational age was found to be a better option compared to expectant management up to 41 weeks in terms of obstetric and perinatal outcomes.

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