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Management and outcome of pregnancy complicated by severe pre-eclampsia of early onset.

Fifty-six patients with severe gestational proteinuric hypertension presenting at less than 32 weeks' gestation with a live fetus were studied to determine complications, possible treatment and outcome. Sixteen patients (28%) were delivered within 72 hours of presentation for maternal or fetal reasons. In 10 patients the blood pressure settled and they received no antihypertensive therapy but 33 patients received oral antihypertensive therapy (mainly monohydralazine and oxprenolol) in an attempt to delay delivery. The mean presentation to delivery interval in these patients was 11.4 +/- 9.1 days with a range of 1 day - 7 weeks, but 17 patients (51.5%) were delivered within 1 week of presentation. The final 13 patients in the series developed serious medical or obstetric complications during the attempt to delay delivery. The caesarean section rate was 75%. There was a 24.5% overall perinatal mortality, and 19% of infants were small for gestational age. Nine infants were delivered before 28 weeks' gestation with only 1 survivor. Antihypertensive therapy allowed delivery to be delayed to after 28 weeks in 11 patients with only 1 perinatal death. The fetal survival was 100% in patients presenting after 30 weeks' gestation. The unpredictability of the course of disease leads to difficulty in deciding the most appropriate management.