Conservative management of early-onset pre-eclampsia and fetomaternal outcome in Nigerians

The aim of this study was to determine the effect of conservative management of pre-eclampsia with onset in the second trimester on fetomaternal outcome. This was a prospective study of 749 consecutive cases of pre-eclampsia seen over a 5-year period in a tertiary care centre in Enugu, Eastern Nigeria. One hundred and seventy-five (23.4%) of the 749 cases started at less than 30 weeks' gestational age. These early-onset cases formed the study group, while the remaining 574 with onset at 30 weeks' gestation or later (the late-onset cases) served as controls. The two groups were compared for some fetomaternal outcome variables at the 95% confidence level. Ninety-one (52%) of the early-onset group had pure pre-eclampsia while the remaining 84 were thought to have pre-eclampsia superimposed on chronic hypertension. The mean gain in gestational age in the early-onset group was 8.8 +/- 1.5 (range: 0-19) weeks. Compared to the late-onset group, the early-onset group had a twofold increase in maternal mortality ratio and a significantly increased incidence of renal failure and HELLP syndrome. The perinatal mortality rate increased fourfold in the early-onset compared to the late-onset group due principally to prematurity and intrauterine growth restriction. The perinatal mortality rate was, however, comparable to results from similar Caucasian studies. It was concluded that there has been an increased incidence of early-onset pre-eclampsia in Nigerian women. Although conservative management of such cases may improve fetal results, it is associated with increased maternal mortality and morbidity because of institutional delays and non-availability of magnesium sulphate at the time of the study. Minimising institutional delays, providing magnesium sulphate and improving neonatal services will enhance maternal and fetal results in early-onset pre-eclampsia in Nigeria and are recommended.