Maternal and perinatal outcomes in women undergoing expectant management of early-onset pre-eclampsia: A retrospective cohort study

Background. Expectant management of early-onset pre-eclampsia, with the aim of improving perinatal outcomes, may increase the risk of maternal morbidity. Objective. To study the maternal and perinatal outcomes and their association with various risk factors in women undergoing expectant management for early-onset pre-eclampsia. Methods. A retrospective cohort study was carried out in a tertiary centre in south India between April 2014 and June 2015. We studied 201 women with singleton pregnancies with pre-eclampsia diagnosed between 28 and 34 weeks' gestation. Demographic data, medication and treatment details, and delivery data were extracted from maternal charts. The primary outcomes were: (i) composite maternal outcomes, defined as the development of any of eclampsia, abruptio placentae, pulmonary oedema or renal failure; and (ii) perinatal mortality. Logistic regression was used to assess the independent association risk factors with primary outcomes, after adjusting for other variables. Results. Sixty-nine women (34.3%) had one or more of the composite adverse maternal outcomes, and there were 74 (36.8%) cases of perinatal mortality. The presence of imminent symptoms (odds ratio (OR)=2.35) and multiparity (OR=2.31) were associated with composite adverse maternal outcomes, whereas low birth weight and breech vaginal delivery were associated with perinatal mortality. Perinatal mortality was higher in women with pre-eclampsia diagnosed between 28 and 30 weeks. Gestational age at diagnosis was not found to be associated with composite adverse maternal outcomes or perinatal morbidity. Conclusion. Expectant management in early-onset pre-eclampsia can be safely considered without increasing maternal risk, after thorough counselling about outcomes, based on the available neonatal facilities in low-resource settings

General pharmacology of Vitex leucoxylon Linn leaves.

Ethanol extract (ETE) and cold aqueous infusion (CAI) of Vitex leucoxylon leaf were evaluated in a battery of tests to define the activity profile of the plant. CAI depressed SMA, antagonised d-amphetamine stereotypy and oxotremorine tremors, shortened the duration of mice immobility in behavioural 'despair' test and lowered serum total cholesterol level. ETE showed significant inhibition of carrageenin paw oedema and granulation tissue formation in rats. Suppression of acetic acid writhing was observed with both ETE and CAI. LD50 value of ETE was > 3000 mg kg-1 (ip) and that of CAI 1050 (800-1200) mgkg-1.