Early onset pre-eclampsia with severe features necessitating fetal delivery: outcome of pregnancies with birthweight 1000-1800g at Tygerberg Hospital 2017
| dc.contributor.advisor | Gebhardt, Gabriel Stefanus | en_ZA |
| dc.contributor.author | Adlam, Jan Andries | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology. | en_ZA |
| dc.date.accessioned | 2021-12-06T09:41:31Z | |
| dc.date.accessioned | 2021-12-22T14:29:31Z | |
| dc.date.available | 2021-12-06T09:41:31Z | |
| dc.date.available | 2021-12-22T14:29:31Z | |
| dc.date.issued | 2021-12 | |
| dc.description | Thesis (MMed)--Stellenbosch University, 2021. | en_ZA |
| dc.description.abstract | Introduction: Expectant management of early onset pre-eclampsia (EOPE) is an established practice at Tygerberg Hospital and some other tertiary institutions in South Africa. Its outcome has been documented in several studies. However, neonatal care has improved since many of these studies were done, e.g., nasal continuous positive airway pressure (NCPAP) plus intubation, surfactant, and extubation (InSurE) (introduced in 2006 at Tygerberg) and therapeutic hypothermia introduced in 2008. It is plausible that an interventionist approach (delivery after 48 hours of optimal maternal and fetal preparation, stabilisation of mother, antenatal corticosteroids and MgSO4 for neuroprotection, fetal evaluation with ultrasound, Doppler and electronic fetal monitoring) with access to good neonatal care can yield the same outcome without subjecting the mother to the additional dangers of expectant management. The women who do not qualify for expectant management (due to maternal or fetal contra- indications) can be a good proxy for an interventionist approach to EOPE. The outcome of ELBW (<1000g) babies at Tygerberg has been described previously. Methods: This was an observational cross-sectional study using data from the routinely collected PPIP database, electronic labour ward register and clinical data from patient folders. All pregnancies complicated by pre-eclampsia with a birthweight of 1000-1800g born at least 24 hours after admission in 2017 at Tygerberg Hospital were identified. Patients admitted for formal expectant management were excluded. By folder review, routine provincial admission and discharge data and mortality data, clinical outcome and neonatal survival were investigated. Findings: 139 Women were identified by total population sampling. The presenting diagnosis was EOPE (122 women, [88%]) LOPE (14 women [10%]) or eclampsia (3 women [2%]). Intra-uterine growth restriction (IUGR) was diagnosed in 41% of cases before delivery. The time to delivery was on average 81 hours. In total, 65 (46.7%) of deliveries were due to fetal indications. Maternal indications for early delivery in the remaining 74 women were: pregnancy that reached 34 weeks (n=28), specialist opinion (n=13), HELLP syndrome (n=7), pulmonary oedema (n=7), severe maternal ascites (n=6), uncontrollable hypertension (n=5), maternal request (n=3), eclampsia (n=3) or acute renal injury (n=2). There were no intrapartum deaths and only two neonatal deaths. The rest of the babies were discharged alive from hospital. For 22 babies, there were no accounts of follow-up visits in the province. Thirty babies iii attended the neurodevelopmental clinic for follow-ups. Of these, three had spastic cerebral palsy and two had fine or gross motor delay. The rest had no major disabilities noted. The remaining 84 babies all had contact with health services during the months after discharge, with minor problems. The mean number of neonatal days in hospital was 20 and ranged from 2 days to 116 days. Conclusion: Neonatal outcomes were acceptable and overall survival was better than the initial study done at Tygerberg Hospital (with 12 neonatal deaths in babies >1000g in the group of 340 women managed expectantly in 1992-1997). With these findings, a rethink of management strategies for pregnancies complicated by severe early onset pre-eclampsia is warranted and a randomised trial is recommended as the next step. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar | af_ZA |
| dc.description.version | Masters | en_ZA |
| dc.format.extent | 59 pages | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/123926 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | Preeclampsia | en_ZA |
| dc.subject | Newborn infants -- Death | en_ZA |
| dc.subject | Pregnant women -- Care | en_ZA |
| dc.title | Early onset pre-eclampsia with severe features necessitating fetal delivery: outcome of pregnancies with birthweight 1000-1800g at Tygerberg Hospital 2017 | en_ZA |
| dc.type | Thesis | en_ZA |