A PROTOCOL FOR MANAGING SEVERE PREECLAMPSIA IN THE 2ND-TRIMESTER

One hundred nine patients with severe preeciampsia in the second trimester were studied. Pregnancy termination was recommended for those with gestational age ≤24 weeks (n = 25), whereas expectant management with aggressive maternal and fetal monitoring was recommended for these with gestational age >24 but ≤27 weeks (n = 84). Ten of the 25 women in the early pregnancy group accepted termination and 15 elected to continue the pregnancy. The overall perinatal survival in the latter 15 patients was 6.7%, and maternal complications developed in six patients. Thirty of the 84 patients in the late second-trimester group had immediate delivery, and 54 had expectant management. The average length of pregnancy prolongation in the expectant group was 13.2 days (range, 4 to 28 days). Compared with the immediate delivery group, the expectant management group had significantly higher perinatal survival (76.4% versus 35.%), significantly higher birth weights (880 versus 709 gm), and a lower incidence of neonatal complications. There were no differences between the two groups with regard to maternal complications. Expectant management with aggressive monitoring of maternal and fetal status at a perinatal center improves perinatal outcome in patients with severe preeclampsia with gestational age >24 but ≤27 weeks. © 1990.