Maternal and Neonatal Outcomes in Expectant Management of Early-Onset Severe Preeclampsia

Preeclampsia is one of the most critical complications of pregnancy observed in 2%-8% of all pregnancies. Severe preeclampsia has many maternal and neonatal complications that are more prevalent in early-onset preeclampsia. The present study aimed to determine the prevalence of maternal and neonatal outcomes of expectant management of severe preeclampsia before 34 weeks of gestation.

In this retrospective descriptive study, the medical records of 55 mothers who had severe preeclampsia before 34 weeks of gestation and underwent expectant management and those of their neonates within 2014-2019 in Kashan, Iran, were reviewed. The information extracted from the medical records included maternal and neonatal demographic variables and outcomes. All data were analyzed in SPSS software (version 16) using descriptive and inferential statistics. The p-values of less than 0.05 were considered significant.

In this study, the rates of seizure, post-partum hemorrhage, intensive care unit admission, and platelet decline were 5.5%, 1.8%, 3.6%, and 7.3%, respectively. Moreover, 10.9% of mothers had renal failure, and therefore, elevated liver enzymes and hemolysis. Among the neonates, 44.7% and 12.7% of the cases had respiratory distress syndrome (RDS) and low Apgar scores, respectively. It was also revealed that 6.4% of the neonates had convulsions and pneumothorax (PTX), and neonatal mortality was observed in 6.4% of them. No significant relationship was observed between maternal outcomes and gestational age and between neonatal outcomes and the number of deliveries (P>0.05). However, renal failure outcomes had a significant relationship with the number of deliveries (P=0.023), meaning that all mothers with renal failure were nulliparous. It was found that gestational age had a  significant relationship with the outcomes of neonatal death, low 5-minute Apgar score, low birth weight, RDS, and PTX (P<0.05); in other words, lower gestational age led to higher mentioned neonatal outcomes.

Expectant management of early-onset preeclampsia was beneficial for neonates, and the implementation of regular and close monitoring in equipped centers would prevent the increase of maternal complications.