Treatment of severe pre-eclampsia by plasma exchange

Three women will with pre-existing renal disease developed severe pre-eclampsia with renal failure during the midtrimester of pregnancy. Plasma exchange was commenced at 23, 26 and 29 weeks of gestation and continued, initially daily then second daily, until delivery at 32, 29 and 32 weeks, respectively. During this period, signs of pre-eclampsia regressed and renal function stabilised or improved. One baby with severe hyaline membrane disease died at 6 days; the other 2, now aged 7 months and 4 months, are in good health. Plasma exchange may offer an alternative to termination of pregnancy in the management of patients with severe pre-eclampsia when fetal maturity is insufficient for viability.