A Clinical Analysis of Severe PreeclamsiaHypertensive Disorders

Seo, Young Seok; Song, Chan Ho; Lim, Sang Hyuk; Park, Sun Kook; Song, Keun Il; Nam, Sang Ryun

Abstract

Traditionally, preeclamptic women who meet established criteria for severe disease aredelivered expeditiously. Although delivery is always appropriate thrapy for the mother, itmay not be for the fetus remote from term. The purpose of this investigation was to evaluatethe differences of pregnancy and neonatal outcome of severe preeclampsia and normalpregnancy, especially before 34 weeks gestational age, and to determine whether aggressiveor expectant management of severe preeclampsia before 34 weeks is more beneficial tomaternal and fetal outcome. A hundred and twenty consecutive pregnancies complicated bysevere preeclampsia and a hundred and twenty normal pregnancies were stuided.The results were as follows:1. The incidence of severe preeclampsia was 3.9%(130 of 3328). The 26~30 year oldage group was most common, 43%(52 patients).2. In case of study between severe preeclamptic patients and normal pregnant patient,there was no differences regarding gestational age at delivery, birth weight, cesarean sectionrate, incidence of RDS, perinatal death. The 1min/5 min Apgar scores of severe preeclampsiais significantly lower than control group(6/7 vs 7/8, p < 0.05). Neonates with SGA(small for gestational age) were found in 29% neonates of patients with severe preeclampsia,which is significantly higher than normal pregnancy group(6%, p < 0.05).3. There was no significant difference between expectant(n=10) and aggressive(n=21)management group less than 34 weeks gestation regarding the gestational age of admissionand delivery, blood pressure, proteinuria, serum creatinine, hemoglobin, hematocrit, pletelets,liver enzymes, and LDH. Only the prolongation of gestational age in the expectant managementgroup is significantly higher than in the aggressive management group(7 vs 2 days,p < 0.05).4. The neonatal and pregnancy outcome of expectant(n=10) and aggressive managementgroup(n=15) were as follow: The birth weight in the expectant management groupis lower than in the aggressive management group(1316.7+/-668.8g vs 1576.2+/-428.7 g, p < 0. 05). The incidence of SGA in the expectant management group is higher than in theaggressive management gorup(50% vs 27%, p=not significant). There was no significant differencebetween expectant and aggressive management group regarding the 1 min/ 5 minApgar score, the cesarean section rate, and the frequency of respiratory distress syndrome,cerebral hemorrhage, renal failure, sepsis, DIC of neonates.