A protocol for managing severe preeclampsia in the second trimester.

Abstract

One hundred nine patients with severe preeclampsia in the second trimester were studied. Pregnancy termination was recommended for those with gestational age less than or equal to 24 weeks (n = 25), whereas expectant management with aggressive maternal and fetal monitoring was recommended for those with gestational age greater than 24 but less than or equal to 27 weeks (n = 84). Ten of the 25 women in the early pregnancy group accepted termination and 15 elected to continue the pregnancy. The overall perinatal survival in the latter 15 patients was 6.7%, and maternal complications developed in six patients. Thirty of the 84 patients in the late second-trimester group had immediate delivery, and 54 had expectant management. The average length of pregnancy prolongation in the expectant group was 13.2 days (range, 4 to 28 days). Compared with the immediate delivery group, the expectant management group had significantly higher perinatal survival (76.4% versus 35%), significantly higher birth weights (880 versus 709 gm), and a lower incidence of neonatal complications. There were no differences between the two groups with regard to maternal complications. Expectant management with aggressive monitoring of maternal and fetal status at a perinatal center improves perinatal outcome in patients with severe preeclampsia with gestational age greater than 24 but less than or equal to 27 weeks.