Expectant Management Of Early Onset Preeclampsia: Feasibility And Efficacy

ObjectiveTo explore the feasibility and efficacy of expectant management in early onset preeclampsia.Method115 cases of early onset preeclampsia in 5 years (between January 1999 to December 2004) were studied. All the cases were admitted before 34 gestational age and diagnosed as preeclampsia before or at that time. There is no chronic hypertension, chronic nephritis or nephrotic syndrome before pregnancy. Two groups were classified by prolonging 8 days as Group A (less than 8 days, sixty-seven cases including eight twins, and seventy-five fetus) and Group B (8 or more days, forty-eight cases including ten twins and one triplets, and sixty fetus). Maternal complications and perinatal prognosis were observed.Results1. There is no significant difference in parity, numbers of fetus, gestational age of admission, the highest level of diastolic pressure and the ratio of urine protein in twenty-four hours between the two groups (P>0.05). But maternal age and thehighest level of systolic pressure were statistically different(P=0.004,0.005).2. There is no significant difference in the using of magnesium sulfate, decompression drugs and nutrition supporting (P>0.05). But the days of magnesium sulfate using and the using of dexasone were statistically different (P<0.001).3. The mean days of prolongation were 8.2 days in all the cases, 3.4 days in Group A, 14.8 days in Group B, with significant difference between them (P<0.001).4. There were no significant difference between maternal major complications including hypoproteinemia, hepatic dysfunction, renal dysfunction, anemia, thrombocytopenia, placental abruption, HELLP syndrome and eclampsia(P>0.05).5. There gestational age of delivery (31.8VS 33.2, P<0.001) and birth weight (1583.4VS 1811.2 g, P=0.028) were significantly different.6. Perinatal death was nineteen (14.1%) including fourteen fetal death (thirteen in group A and one in group B with significantly different, P=0.003) and five neonate death (one of twins and two single fetal in group A;one twins in group B without significant difference, P=0.839).7. There was no significant difference in perinatal complications such as premature labor, neonatal asphyxia, neonatal respiratory distress syndrome, fetal growth restriction, transient tachypnea, hyperbilinibinemia, neonatal malformation between the two groups (P>0.05).Conclusions1. Expectant management is feasible and effective in early onset preeclampsia. hi the balance of maternal-fetal condition, expectant management can prolong gestation age and get better prenatal prognosis.2. It is the critical time that the first twenty-four hours after admission. Dexasonecould be used to prompt the maturity of fetal lung in this period and decision could be made to continue expectant management or terminate immediately according to the situation.3. It is of vital importance to monitor maternal and fetal situation intimately in the course of expectant management, which could make accurate judgment in time and deal with any omen properly to avoid serious maternal complications and fetal death.4.Early onset preeclampsia should be deal with in tristeranty hospital. Sufficient neonatal intensive care unit appliance and serve would show positive effect in reducing neonatal complications.