Early-Onset Severe Preeclampsia in Nigerian Women: Determining a Balance between Maternal Wellbeing and Fetal Survival in a Resource-Limited Setting

Abstract

Background: Preeclampsia in Nigerian women is considered to have a rapidly progressive clinical course. Aim: In the present study we sought to determine the most appropriate gestational age (GA) for delivery in severe preeclampsia occurring preterm to achieve optimal neonatal outcome, without causing undue maternal compromise. Study Design: A retrospective cohort study. Place and Duration of Study: Department of Obstetrics & Gynecology, University of Benin Teaching Hospital, Benin City, Nigeria between June 2012 and May 2014. Methodology: Information on the sociodemographic characteristics, clinical management and outcome of women with severe preeclampsia was extracted from case records and analyzed using SPSS 20.0 and GraphPad InStat 3 software. Results: We included 312 women in the study. The median GA at delivery was 35 weeks. The incidence of eclampsia was 2.5% (102/4,106). Eclampsia occurred 1.5-fold, 1.6-fold and 1.6-fold more, respectively with proteinuria of ≥ 3+, severe anemia and mean arterial blood pressure ≥ 120 mmHg (P=0.00, P=0.00 and P=0.00, respectively). Eclampsia, severe anemia and proteinuria ≥ 3+ were associated with maternal mortality (14.7% vs 0, P=0.00; 28.5% vs 3.7, P=0.00; and 7.6% vs 0.8, P=0.00, respectively). Logistic regression analysis showed that delivery before 34 weeks gestation was associated with early neonatal death (P=0.00). Conclusions: Severe preeclampsia occurring preterm is associated with significant perinatal mortality in our hospital. An approach of selective conservative management up to 34 weeks gestation could improve fetal salvage rate.