Impact of Early-Onset Severe Pre-eclampsia on Maternal and Perinatal Outcomes, Assessing the Role of Expectant Management: A Prospective Observational Study

Abstract

 Introduction: Early-onset severe pre-eclampsia (EOSP) is a critical hypertensive disorder arising before 34 weeks of gestation, significantly impacting maternal and neonatal outcomes. The condition necessitates challenging decisions regarding the timing of delivery to balance maternal safety with fetal development risks. Objective: This study aims to assess maternal and neonatal outcomes associated with expectant versus immediate delivery management in EOSP cases before 30 weeks of gestation. Methods: Conducted as a prospective observational study at Bangalore Medical College and Research Institute from January 2023 to March 2024, 142 women with EOSP diagnosed before 30 weeks were enrolled. Expectant management aimed to extend pregnancy by at least 48 hours, while immediate delivery was chosen when necessary. Key maternal and neonatal parameters were compared between the two groups using t-tests and chi-square tests to evaluate outcomes. Results: Of the 142 participants, 100 underwent expectant management, and 42 delivered immediately. Neonates in the expectant group had significantly higher weights (486.79 ± 253.12 g) than the immediate delivery group (330.03 ± 366.59 g, p < 0.05). Antepartum fetal demise was notably higher in the immediate delivery group, while expectant management resulted in improved live birth rates and higher APGAR scores (p < 0.05). Maternal complications, including uncontrolled hypertension (35.9%) and HELLP syndrome (23.2%), were common across groups but were not significantly exacerbated by expectant management. Conclusion: Expectant management in EOSP before 30 weeks can enhance neonatal outcomes by improving birth weight and reducing stillbirth rates, though it must be carefully managed to mitigate maternal risks. Collaborative obstetric and neonatal care are essential for optimizing outcomes in this high-risk

population