Management of pre-eclampsia remote from term

Abstract

The desired goal in the management of patients with pre-eclampsia is safety of the mother first and then delivery of a live mature newborn that will not require intensive and prolonged neonatal care. Initial management includes maternal hospitalization for evaluation of maternal and fetal conditions. Subsequent management is individualized based on the above evaluation and fetal gestational age. Expectant management results in good pregnancy outcome in most patients with mild disease remote from term. For patients with severe disease, the success rate of expectant management will depend on both fetal gestational age and maternal and fetal conditions at time of hospitalization. In general, maternal and perinatal complications are significantly increased in patients with severe disease prior to 34 weeks' gestation and in those with HELLP syndrome. Thus, these patients should be managed only at regional hospitals with adequate maternal and neonatal intensive care facilities. Finally, patients with pre-eclampsia are at increased risk for recurrence of pre-eclampsia in subsequent pregnancies.