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Pregnancy outcomes among women with early-onset severe preeclampsia managed conservatively

Background: Conservative management of early-onset severe preeclampsia is gaining widespread acceptance among obstetricians despite well-known maternal risks associated with it. There is limited data on the outcome of pregnancy of women managed with this modality of management in Nigerian setting. Objective: We determined the maternal and perinatal outcome of women managed conservatively for early-onset severe preeclampsia. Materials and Methods: This was a 7-year retrospective study of 118 women with early-onset severe preeclampsia that were managed conservatively at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The data were entered and analyzed using the SPSS software version 22.0 (SPSS Inc., Chicago, IL, USA). Results: The median duration of expectant management was 12 days (range 3–20 days). The mean gestational age at delivery was 33.4 ± 2.5 weeks. The most common indication for delivery was uncontrolled hypertension (35.6%). Adverse maternal outcomes found in the study included abruptio placentae (11%), acute renal failure (2.5%), pulmonary edema (0.8%), eclampsia (11.9%), disseminated intravascular coagulation (2.5%), Haemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (2.5%), and maternal death (2.5%). Perinatal mortality occurred in 68 (57.6%) cases in the study. Perinatal survival improved significantly with gestational age, with reductions in perinatal mortality of approximately 50% per week between 28 and 34 weeks' gestation on admission. Conclusion: Delayed delivery of women with early-onset severe preeclampsia improved perinatal outcome in this study, but it was associated with considerable maternal morbidity and mortality. Therefore, proper patient selection, adequate counseling of women on the risks and benefit of conservative management, close maternal monitoring, and the presence of advanced neonatal care are necessary to optimize pregnancy outcome when this management modality is adopted.