Perinatal outcomes following expectant management of severe Preeclampsia at Mtrh, Eldoret, Kenya

Abstract

Background: Preeclampsia occurs in about 5 to 12% of all pregnancies. Early severe preeclampsia accounts for 25% of all cases of preeclampsia. PET is the leading cause of maternal and perinatal morbidity and mortality. The only known treatment for preeclampsia is delivery, yet an early preterm delivery increases the risk for adverse neonatal outcomes. Despite its significance both nationally and at the Moi Teaching and Referral Hospital, there is paucity of information on the perinatal outcomes of severe preeclampsia managed conservatively remote from term. Further, there are no local studies to define the appropriate gestational age at which to initiate conservative management of severe pre-eclampsia remote from term by way of perinatal outcomes. In this regard, research was carried out in Moi Teaching and Referral Hospital Eldoret, Uasin Gishu County, Kenya to examine perinatal outcomes of expectant management of severe preeclampsia among women managed conservatively remote from term at MTRH‘s maternity unit in Eldoret- Kenya Objective: To investigate the perinatal outcomes of severe preeclampsia among women managed conservatively at the Moi Teaching and Referral Hospital maternity unit in Eldoret, Kenya. Methods: This was a prospective study done at MTRH. A total of 72 women from 28 weeks gestation to 34 weeks gestation with severe preeclampsia were enrolled from admission to delivery and followed up for 7 days post delivery with outcomes evaluated. Expectant management was given whenever there was no indication for immediate delivery as per the hospital severe preeclampsia treatment protocol. The perinatal outcome of this expectant management was recorded and appropriate statistical analysis was carried out. Relevant data was collected using a semi structured questionnaires, entered into a computer access database, cleaned and analyzed using SPSS. Association between categorical variables was conducted using Pearson‘s Chi Square test and Fishers exact test. Descriptive data was summarized and presented using tables and graphs. Inferential statistics were presented using odd ratios and tabulated showing their P value (p <0.05). Outcomes of interest included pregnancy prolongation, intrauterine fetal death, and birth weight, Apgar score at 5 minutes, newborn unit admission, and newborn status on day 7. Results: The mean age was 27.9+/- 6.6 years (range 16-43 years).The median pregnancy prolongation was 7 days. The majority (93%) of newborns had a birth weight less than 2500 grams. There were 24 perinatal deaths. Apgar score below 7 occurred in 8 (11.1%) newborns. More than half of newborns (51.4%) were admitted to the newborn unit. More than two thirds of babies (66.7%) were alive on day 7. Conclusion: There was a mean pregnancy prolongation of a week with expectant management of early severe preeclampsia. Recommendations: More studies are recommended in the area of early severe preeclampsia since the disease contributes to high mortality and morbidity in our setup. Pediatric follow up of newborns to document long term effect if any after expectant management of early severe PET