Expectant management of early onset, severe pre-eclampsia: perinatal outcome

BJOG. 2000 Oct;107(10):1258-64. doi: 10.1111/j.1471-0528.2000.tb11617.x.


Objective: To evaluate the perinatal outcome of expectant management of early onset, severe pre-eclampsia.

Design: Prospective case series extending over a five-year period.

Setting: Tertiary referral centre.

Population: All women (n = 340) presenting with early onset, severe pre-eclampsia, where both mother and the fetus were otherwise stable.

Methods: Frequent clinical and biochemical monitoring of maternal status with careful blood pressure control. Fetal surveillance included six-hourly heart rate monitoring, weekly Doppler and ultrasound evaluation of the fetus every two weeks. All examinations were carried out in a high care obstetric ward.

Main outcome measures: Prolongation of gestation, perinatal mortality rate, neonatal survival and major complications.

Results: A mean of 11 days were gained by expectant management. The perinatal mortality rate was 24/1,000 (> or = 1,000 g/7 days) with a neonatal survival rate of 94%. Multivariate analysis showed only gestational age at delivery to be significantly associated with neonatal outcome. Chief contributors to neonatal mortality and morbidity were pulmonary complications and sepsis. Three pregnancies (0.8%) were terminated prior to viability and only two (0.5%) intrauterine deaths occurred, both due to placental abruption. Most women (81.5%) were delivered by caesarean section with fetal distress the most common reason for delivery. Neonatal intensive care was necessary in 40.7% of cases, with these babies staying a median of six days in intensive care.

Conclusion: Expectant management of early onset, severe pre-eclampsia and careful neonatal care led to high perinatal and neonatal survival rates. It also allowed the judicious use of neonatal intensive care facilities. Neonatal sepsis remains a cause for concern.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antihypertensive Agents / therapeutic use
  • Calcium Channel Blockers / therapeutic use
  • Female
  • Fetal Monitoring / methods
  • Humans
  • Infant Mortality
  • Infant, Newborn
  • Intensive Care, Neonatal / statistics & numerical data
  • Length of Stay
  • Male
  • Methyldopa / therapeutic use
  • Multivariate Analysis
  • Nifedipine / therapeutic use
  • Prazosin / therapeutic use
  • Pre-Eclampsia / prevention & control*
  • Pregnancy
  • Pregnancy Outcome
  • Prospective Studies


  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Methyldopa
  • Nifedipine
  • Prazosin