Expectant management in preeclampsıa

Outcome of preeclampsia is changed depending on severity. Maternal and perinatal mortality and morbidity in the hospitalized case with mild preeclampsia are extremely low and approaches those of nor-motensive pregnancies. İn contrast in case of severe preeclampsia the maternal and perinatal mortality are very high. The most effective therapy for severe preeclampsia and eclampsia is delivery of the fetus and placenta. There is universal agreement that all such patients should be delivered at or after 32-34 week's gestation. Depending on the situation, delivery has to be taken into account in severe preeclampsia between 28 and 32 weeks' gestation. At this stage, the neonatal mortality is not veıy high depending on the ability and experience of the neonaLal intensive care unit10. Aggressive management with immediate delivery will result in extremely high neonatal mortality and morbidity. in contrast attempts to prolong pregnancy may result in fetal demise and high maternal morbidity and mortality. There was no structured policy to deliver the cases with severe preeclampsia in the first period of the study (1989-91). In the seconel part (1991-99), llıe cases vvere classified as moderate preeclampsia if there is hypertension (Diastolic pressure more than 100 mm/Hg), proteinuria less tham 5gr/l and no any other pathological signs for severity. Moderate preeclampsia were managed consei"vatively. The outeomes were reviewed retrospeetively. There were 252and 188 cases with hypertension in the two period of the study (ye-ars of 1989-91 and 1991-99) respeetively. The perinatal mortality are 182%o and I42%o retrospeetively. ALso There were 5 cases of maternal mortality in 252 patients and 1 case in 188 cases in this two groups of patients. it has been achieved betler outcome in cases with the elassification of moderate preeclampsia by expeclant management. 1) Chronic hypertension 2) gestational hypertension (appearecl in this pregnancy without prote¬inuria) 3) Mild preeclampsia (Hypertension less than 110 mm/Hg diastolic pressure and proteinuria >ü.5 gr/L and <5 gr/L) 4) Moderate preeclampsia (Hypertension equal or more than 110 mm/Hg diastolic pres¬sure and proteinuria less than 5 gr/L, no other clinical/laboratory signs for severity) 5) Severe preeclamp¬sia (Hypertension equal or more than 110 mm/Hg and/or proteinuria more than 5 gr/L, and/or clinical-laboratory sign for severity such as oliguria, seotom, headache, confusion, epigastric pain, retinal ha-emorrhage, pulmonaıy oedema, HELLP syndrome) or (a moderate preeclampsia which can not be undercontrolled by antihypertensive therapy) 6) Superimposed preeclampsia 7) Eclampsia. The cases with moderate preeclampsia, as classified above, can be managed with expectant management. At this stage of pathophysiology blood supply from mother to placenta and fetus can be achieved by inc-reased blood pressure. The pathophysiology is not generally systemic and the organ systems of the mother are not compromised. There is no inereased risk for the mother but fetal morbidity and mortality are very high in which fetal well being should be undertaken as a main approach. Another important poinl is that the expectantly managed pregnant should be hospilalized and follovved intensively for the proba-bility of severe form of preeclampsia vvhich can cau.se severe maternal morbidity and mortality.

Anahtar Kelimeler

1. Odendaal H.J., Paltinson R.C., Banı R. (1990)Aggressive or expectant management for patients with severe preeclampsia betvveen 28-34 weeks gestation: a randomized controlled trial. Obstet Gynecol, 76,1070-3
2. Fenakel K., Fenakel E., Appleman Z, Lurie S..Katz Z., Shoham Z. (1991) Nifedipine in the treatment of severe preeclampsia. Obstet Gynecol, 77, 331-4
3. American College of Obstetricians and Gynecologists (1986). Management of preeclampsia. Washington, DC: American College of Obstetricians and Gynecologists, Technical Bulletin 91 5. Sibai B.M., Baıton J.R., Akl S., Sarinoglu C, Mercer B.M. (1992) A randomized prospeetive comparison of nifedipine and becl rest versus bed rest alone in the management of preeclampsia remote from term. AmJ Obstet Hynecol. 167,879-84