Maternal and Perinatal Outcomes in Women Undergoing Expectant Management of Early-Onset Preeclampsia: A Retrospective Cohort Study

摘要

Background:Expectant management for early-onset preeclampsia, with the aim to improve the perinatal outcome may increase the risk of maternal morbidity.The objective was to?study the?maternal and perinatal outcomes?and its assocaition with various risk factors?in women undergoing expectant management for early onset preeclmpsia.Methodology:Retrospective cohort study was done in a tertiary center in south India between?April 2014 to June 2015.We?studied?201?women with singleton pregnancies diagnosed preeclampsia diagnosed between 28-34 weeks of gestation.Demographic data,medications and treatment details,and delivery data were abstracted from maternal charts.Primary outcomes were (i) composite maternal?outcomes defined as development of any of eclampsia,? abruptio placentae,pulmonary edema or renal failure and?(ii)?perinatal mortality.Logistic regression was used to?assess the independent association?risk factors with primary outcomes after adjusting for other variables.Results:Sixty-nine women (34.3%) had?one or more of the composite adverse maternal outcomes and 74 (36.8%) had perinatal mortality. Presence of imminent symptoms (OR=2.35) and multiparty (OR=2.31) were associated with composite adverse maternal outcomes whereas low birth weight and breech vaginal delivery were associated with perinatal mortality.Perinatal mortality was higher in women preeclampsia diagnosed between 28-30 weeks.Gestational age at diagnosis was not found to be associated with composite adverse maternal outcomes or perinatal morbidity.Conclusions:Expectant management in early onset preeclampsia can be safely considered without increasing maternal risk, after thorough counselling about outcomes based on the available neonatal facilities in low resource settings.