Objective
To study the maternal and perinatal outcomes in women with severe pre‐eclampsia before 28 weeks of pregnancy.
Methods
A descriptive study from a tertiary care center. All consecutive women with severe pre‐eclampsia withonset before 28 weeks of pregnancy were included. The details were collected in a predesigned structured proforma prospectively.
Results
The study cohort included 145 women with a mean maternal age of 26.97 ± 5.36 years (range 19–47 years). The mean duration of prolongation of pregnancy was 13.04 ± 10.57 days (range 1–51 days). A total of 29.7% (n = 43) of women had at least one major adverse maternal outcome, and the most common was HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome (n = 24,16.6%), followed by eclampsia (n = 12,8.3%). The stillbirth rate was high (n = 103,68.7%), and most occurred in the antepartum period. Of 47 (31.3%) neonates born alive, only eight (17.02%;8/47) survived up to 28 days of life. Fetal growth restriction with Doppler abnormalities and neonatal sepsis were the most common reasons for perinatal mortality.
Conclusion
Expectant management should not be considered routinely when the onset of severe pre‐eclampsia is before 25+6 weeks of pregnancy. Between 26 and 27+6 weeks it can be offered under close monitoring and the perinatal survival depends on the neonatal services available in their facility.
Lymphangiomas are benign cystic lesions caused by the failure of lymphatics to communicate with the lymphatic-venous drainage system. They have an incidence at birth of about 1 in 6000 and can occur at almost any location, most commonly the soft-tissues of the neck. Prenatal diagnosis is by ultrasound, where they appear as cystic masses of variable size, often with septations inside and absent flow on color doppler. Antenatal management involves serial monitoring of the fetus by ultrasound with attention to possible pressure effects and airway obstruction depending upon the size and location of the lymphangioma. The mode of delivery must be decided based on the possibility of obstructive labor or the need for resuscitation. Rarely, a large mass over the anterior neck causing airway obstruction may need an EXIT procedure.Large cystic hygromas need surgical excision while small to medium size lesions can be managed by conservative measures including sclerotherapy. We report three cases of isolated fetal cystic hygromas diagnosed prenatally at various gestations. Two were of moderate size over the anterolateral aspect of the neck and one case had a huge lymphangioma involving the entire right side of the chest wall.
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