Delivery outcomes of patients with pre-eclampsia at 27 - 34 weeks’ gestation at Tygerberg Hospital, Cape Town, South Africa: A retrospective observational study
Autor: | L de Waard, C J B Muller, S E Olivier, G S Gebhardt |
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Rok vydání: | 2021 |
Předmět: |
Adult
medicine.medical_specialty Hypertension in Pregnancy Population Gestational Age Umbilical Arteries Preeclampsia South Africa Pre-Eclampsia Pregnancy Birth Weight Humans Medicine Labor Induced education Retrospective Studies education.field_of_study Eclampsia Cesarean Section business.industry Obstetrics Infant Newborn Pregnancy Outcome Retrospective cohort study General Medicine Delivery Obstetric medicine.disease Cohort Gestation Female business |
Zdroj: | South African Medical Journal. 111:437 |
ISSN: | 2078-5135 0256-9574 |
Popis: | Background. Obstetricians are cognisant of the serious nature of hypertensive disorders in pregnancy. Despite a 17% overall reduction in maternal deaths in South Africa between 2011 and 2016, there was a 14% increase in deaths due to hypertension. Delivery is the only known cure for pre-eclampsia, but the question regarding the safest route of delivery remains difficult to answer. Objectives. To determine the success rate of induction of labour (IoL) in patients with early-onset pre-eclampsia with severe features (EOPES) before 34 weeks’ gestation. Furthermore, the data from the induction group were compared with those of the caesarean delivery (CD) groups where patients were not eligible for IoL. Additional objectives were to identify variables that could influence the success rate, to determine whether any delivery method was associated with increased morbidity, to assess the short-term maternal and neonatal outcomes, and to make recommendations for future decision-making regarding delivery for women with EOPES. Methods. In this single-institution retrospective observational study, all cases in which a decision for delivery was made before 34 weeks 0 days of gestation (or the infant’s birthweight was ≤2 000 g with uncertain gestation) at Tygerberg Hospital, Cape Town, between 1 January and 30 June 2017 were identified from the electronic birth register. The cohort fitting the inclusion criteria was subdivided into IoL and CD groups. Results. From a total of 3 938 deliveries, 168 patients met the inclusion criteria. IoL was indicated in 55 cases, resulting in 20 vaginal deliveries (VDs) (36%) and 35 CDs (64%). The remaining 113 patients were not candidates for IoL; of these, 89 required emergency CDs and 24 had semi-elective CDs. In the IoL group with abnormal umbilical artery Dopplers (UADs) there was 1 VD, and 4 CDs were performed for fetal compromise. Of cases with an estimated fetal weight (EFW) ≤3rd centile, emergency CD was required in 24 (65%), and 8 (22%) were considered for IoL, in 6 of which CD was required. Conclusions. Of the EOPES population, 36% had successful IoL that culminated in VD. VD was more likely to occur with fetal growth appropriate for gestational age. The likelihood of CD increased if the UAD was abnormal, if the EFW was ≤3rd centile or if eclampsia was present. The decision to induce should be considered carefully in these circumstances. |
Databáze: | OpenAIRE |
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