A Prospective Observational Study to Compare Risks and Benefits of Aggressive with Expectant Management of Severe Preeclampsia between 28 To 34 Weeks of Gestation

Abstract

Background: Severe preeclampsia between 28 to 34 weeks of gestation presents a major obstetric challenge, where the only definitive treatment is delivery, yet early delivery exposes the fetus to complications of prematurity. The present study was undertaken to compare the risks and benefits of aggressive management (delivery within 48 hours of admission) versus carefully supervised expectant management (delivery after 48 hours of admission) in women with severe preeclampsia between 28 to 34 weeks of gestation.

Materials and Methods: This institution-based observational prospective comparative study included 100 pregnant women between 28 to 34 weeks of gestation diagnosed with severe preeclampsia; they were equally divided into two groups- 50 managed aggressively and 50 managed expectantly. Clinical details relevant to maternal, fetal and neonatal outcome of both groups were collected and compared. The data were analyzed using SPSS software (version 27.0).

Results: Termination of pregnancy in the expectant management was done mostly for maternal indications (66%) rather than fetal indications (34%). The mean prolongation of pregnancy in the expectant management was 8.32±2.87 days and it was statistically significant (p<0.0001). Though the maternal complications were slightly higher (38% vs. 24%) with the expectant management, but it was not statistically significant (p = 0.9811). Majority of the newborn baby in the expectant management group (62%) had significantly high (≥7) APGAR score at 5 minutes (p=0.0163). NICU/ SNCU admission (p<0.0001) and perinatal mortality (p=0.0006) were lower in the expectant management group with statistical significance.

Conclusions: Optimizing maternal and perinatal outcome is the key in the management of early onset severe preeclampsia. Expectant management results in a better obstetric outcome and should be done only in well selected patients in a tertiary care centre.