Premium
Early onset severe pre‐eclampsia: expectant management at a secondary hospital in close association with a tertiary institution
Author(s) -
Oettle Charl,
Hall David,
Roux Adele,
Grové Debbie
Publication year - 2005
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2004.00262.x
Subject(s) - medicine , fetal distress , obstetrics , placental abruption , tertiary referral hospital , eclampsia , tertiary care , gestation , pediatrics , population , fetus , tertiary institution , pregnancy , retrospective cohort study , emergency medicine , surgery , genetics , environmental health , medical education , biology
Objectives Early onset severe pre‐eclampsia is ideally managed in a tertiary setting. We investigated the possibility of safe management at secondary level, in close co‐operation with the tertiary centre. Design Prospective case series over 39 months. Setting Secondary referral centre. Population All women ( n = 131) between 24 and 34 weeks of gestation with severe pre‐eclampsia, where both mother and fetus were otherwise stable. Methods After admission, frequent intensive but non‐invasive monitoring of mother and fetus was performed. Women were delivered on achieving 34 weeks, or if fetal distress or major maternal complications developed. Transfer to the tertiary centre was individualised. Main outcome measures Prolongation of gestation, maternal complications, perinatal outcome and number of tertiary referrals. Results Most women [ n = 116 (88.5%)] were managed entirely at the secondary hospital. Major maternal complications occurred in 44 (33.6%) cases with placental abruption (22.9%) the most common. One maternal death occurred and two women required intensive care admission. A mean of 11.6 days was gained before delivery with the mean delivery gestation being 31.8 weeks. The most frequent reason for delivery was fetal distress (55.2%). There were four intrauterine deaths. The perinatal mortality rate (≥1000 g) was 44.4/1000, and the early neonatal mortality rate (≥500 g) was 30.5/1000. Conclusions The maternal and perinatal outcomes are comparable to those achieved by other tertiary units. This model of expectant management of early onset, severe pre‐eclampsia is encouraging but requires close co‐operation between secondary and tertiary institutions. Referrals to the tertiary centre were optimised, reducing their workload and costs, and patients were managed closer to their communities.