Early onset severe pre-eclampsia: Expectant management at a secondary hospital in close association with a tertiary institution

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dc.contributor.authorOettle C.A.
dc.contributor.authorHall D.
dc.contributor.authorRoux A.
dc.contributor.authorGrove D.
dc.date.accessioned2011-05-15T16:15:42Z
dc.date.available2011-05-15T16:15:42Z
dc.date.issued2005
dc.description.abstractObjectives: 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.
dc.description.versionArticle
dc.identifier.citationBJOG: An International Journal of Obstetrics and Gynaecology
dc.identifier.citation112
dc.identifier.citation1
dc.identifier.issn14700328
dc.identifier.other10.1111/j.1471-0528.2004.00262.x
dc.identifier.urihttp://hdl.handle.net/10019.1/13449
dc.subjectadolescent
dc.subjectadult
dc.subjectarticle
dc.subjectdelivery
dc.subjectdisease severity
dc.subjectfemale
dc.subjectfetus death
dc.subjectfetus distress
dc.subjectfetus monitoring
dc.subjecthospital
dc.subjecthospital admission
dc.subjecthuman
dc.subjectintensive care
dc.subjectmajor clinical study
dc.subjectmaternal mortality
dc.subjectnewborn mortality
dc.subjectoutcomes research
dc.subjectperinatal care
dc.subjectperinatal mortality
dc.subjectpreeclampsia
dc.subjectpregnancy complication
dc.subjectpremature labor
dc.subjectpriority journal
dc.subjectsolutio placentae
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAnticonvulsants
dc.subjectAntihypertensive Agents
dc.subjectBetamethasone
dc.subjectFemale
dc.subjectGlucocorticoids
dc.subjectHospitalization
dc.subjectHumans
dc.subjectInfant Mortality
dc.subjectInfant, Newborn
dc.subjectMagnesium Sulfate
dc.subjectMethyldopa
dc.subjectPre-Eclampsia
dc.subjectPregnancy
dc.subjectPregnancy Outcome
dc.subjectPregnancy Trimester, Second
dc.subjectPregnancy Trimester, Third
dc.subjectProspective Studies
dc.subjectReferral and Consultation
dc.subjectSouth Africa
dc.titleEarly onset severe pre-eclampsia: Expectant management at a secondary hospital in close association with a tertiary institution
dc.typeArticle
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