Expectant management of superimposed preeclampsia on chronic hypertension at the onset of 22 weeks’ gestation: A case report

Abstract

Conservative management in chronic hypertensive women superimposed with preeclampsia poses a threat of grave maternal complications, but may not improve perinatal survivals particularly in cases with preeclampsia in early gestations. This report presents a case of surviving baby after expectant management although the pregnancy complicated with superimposed preeclampsia at the onset of pre-viable gestational age. A 35-year-old Thai pregnant woman, underlying with pregestational diabetes mellitus class F and chronic hypertension, was diagnosed as superimposed preeclampsia at 22 weeks of gestation. She refused elective termination and continued her pregnancy until 32 weeks of gestation. Cesarean section was performed and delivered a female baby with birth weight of 1,655 grams and Apgar scores of 10 at both 1 and 5 minutes. The mother was discharged against advice on day 6 after delivery. Complications developed in the newborn included respiratory distress syndrome, patent ductus arteriosus, pneumonia, sepsis, hyperbilirubinemia, necrotizing enterocolitis and bronchopulmonary dysplasia. However, the baby could be taken home at the age of 68 days and her development was within normal limit at the age of 16 months.