[Clinical delimitation and expectant management of early onset of severe pre-eclampsia].

OBJECTIVE

To determine the clinical delimitation and to investigate the difference of maternal and perinatal outcome with expectant management of women with early onset of severe preeclampsia.

METHODS

Two hundred and fifty-five cases meeting the criteria of severe pre-eclampsia who underwent expectant management were enrolled in this study. Patients were divided into 4 groups: group A (n = 24) with onset before 28 weeks of gestation, group B (n = 50) with onset during 28 - 31 weeks of gestation, group C (n = 34) with onset during 32 - 33 gestational weeks, and group D (n = 147) with onset >or= 34 weeks of gestation. Main outcome measures included prolongation of gestation, perinatal mortality rate, and small for gestational age as well as major complications.

RESULTS

The average pregnancy prolongation was (9 +/- 3) days (range 1 to 40), (11 +/- 8) (range 1 to 28), (8 +/- 6) (range 1 to 21), and (5 +/- 4) (range 1 to 21), respectively in groups A, B, C and D. The gestational age at delivery was closely associated with the perinatal outcome. When a cut-off point was set at 34-week gestation, perinatal outcome was only associated with the gestational age at birth. If the cut-off point was set at 32-week gestation, perinatal morbidity and mortality were associated with both gestational age at birth and the onset of severe preeclampsia during pregnancy.

CONCLUSIONS

The clinical delimitation of early onset of severe preeclampsia at 32-week gestation is significantly associated with poor maternal and perinatal outcome. Expectant management should be carried out in well-selected patients with severe preeclampsia remote from term, individually.