Severe Preeclampsia Before 34 Weeks of Amenorrhea: Management and Maternal-Fetal Prognosis

Introduction: Pre-eclampsia is said to be severe when associated with severe hypertension, i.e. PAS≥ 160 mmHg or PAD ≥ 110 mmHg, or when accompanied by clinical and/or biological signs of visceral distress. It is said to be early if it occurs before 34SA. This study aimed to describe the epidemiological profile of women hospitalized for severe pre-eclampsia before 34 weeks gestation, determine the management modalities et evaluate the maternal-fetal prognosis. Materials and Methods: This is a retrospective descriptive study carried out in the gynecology and obstetrics department at Ibn Jazzar University Hospital in Kairouan-Tunisia. Our study is conducted over 2 years from January 1, 2021, to December 31, 2023. Results: We selected a total of 160 patients, representing a prevalence of 1.14%. The mean term on admission was 29SA+3 days. Blood pressure was greater than 180/110mmHg in 17.5% of patients. 22 patients had hepatic cytolysis. Intrauterine growth retardation was observed in 29.4% of cases, and oligohydramnios in 14.4%. 9 pregnancies were complicated by fetal death in utero. Umbilical Doppler was pathological in 20% of cases. 81% of patients were on antihypertensive treatment; 27% were on dual therapy. 91.9% of patients had received corticosteroid therapy and 52.5% had received magnesium sulfate. 24-hour proteinuria (PU 24h) averaged 4.8g/24h. The mean gestational age at delivery was 30SA+4 days, and delivery was by cesarean section in 91.9% of cases, with 128 live newborns and 33 cases of therapeutic termination of pregnancy. 74.2% of births were transferred to the neonatal intensive care unit. Post-partum, 10.6% of patients developed HELLP syndrome, and 20 patients required transfer to the intensive care unit. The average hospital stay was 7 days. Conclusion: Corticosteroid therapy and magnesium sulfate are essential in this pathology to improve the maternal-fetal prognosis before fetal extraction, which is the only etiological treatment.