Objective: We aimed to (i) assess maternal and perinatal outcomes in pre-eclampsia at < 25(0) weeks; and (ii) determine if any antenatal factors were associated with adverse maternal and perinatal outcomes.

Design: A retrospective study.

Setting: Tertiary referral hospital, Auckland, New Zealand.

Methods: Data were extracted from the clinical record and hospital database. The study population involved women admitted with pre-eclampsia at < 25(0) weeks, with a live singleton pregnancy, from 1997 to 2004 and managed expectantly.

Outcome measures: Maternal morbidity, perinatal death, neurodevelopmental outcome at 18 months, small for gestational age assessed by population and customised birthweight centiles.

Results: Gestation at admission was the only antenatal variable associated with adverse perinatal outcome. Of 14 women admitted < 23 weeks, no babies survived, but eight (62%) babies of women admitted in the 24th week (24(0)-24(6)) survived. Neurodevelopmental outcome was assessed in eight of nine survivors; two (25%) had moderate and two (25%) had minor disability. All babies in this cohort had birthweights < 5th customised centile. Only one baby (10%) weighing < 500 g survived.

Conclusion: Maternal morbidity was high in this expectantly managed cohort. As no babies survived when pre-eclampsia occurred before 23 weeks, induction of labour should be considered. In the 24th week two-thirds of babies survived and 25% had moderate handicap. This information may help clinicians and women in the future to make informed choices about management.