Epidemiology and prognostic factors for successful expectant management of early-onset severe features preeclampsia: A retrospective multicenter cohort study

ElsevierVolume 30, December 2022, Pages 226-231Pregnancy HypertensionAuthor links open overlay panelAbstractBackground

To determine the incidence of early-onset severe features preeclampsia among pregnant women and compare maternal complications and perinatal outcome characteristics of expectance and immediate delivery management with identified prognosis factors for successful expectant management.

Materials and methods

A retrospective descriptive multicenter cohort study of pregnant women diagnosed with severe features preeclampsia before 34 weeks of gestation according to the American College of Obstetricians and Gynecologists guidelines was conducted at Khon Kaen University, Srinagarind Hospital and Khon Kaen Hospital between January 1, 2015 and December 31, 2019. Medical records were reviewed for incidence of early-onset severe features preeclampsia, with maternal complications and perinatal outcome characteristics compared for expectant and immediate delivery management.

Results

In total, 42,948 deliveries were recorded during the study period. Of these, 971 were diagnosed with severe features preeclampsia (22 per 1,000 deliveries). Two hundred and sixty-five women (6.3 per 1,000 deliveries) were diagnosed with early-onset severe features preeclampsia before 34 weeks of gestation. No differences were recorded in characteristics between the expectant and delivery management groups. Perinatal outcomes were significantly different between the expectant and delivery management groups; birth weight below 1,500 g (23.5 % versus 58.9 %, p < 0.001), neonatal intensive care unit (65.9 % versus 87.2 %, p < 0.001); neonatal resuscitation (22.3 % versus 57.1 %, p < 0.001). Birth asphyxia, stillbirth and intrapartum death only occurred in women with early-onset severe features preeclampsia in the delivery management group.

Conclusions

Incidence of early-onset severe features preeclampsia was 6.3 per 1,000 deliveries. For women with complications such as early-onset severe features preeclampsia, expectant management significantly benefitted neonatal outcomes, with no differences in maternal outcomes compared to the immediate delivery management group. The gestational age at diagnosis of more than 30 weeks and uric acid level of less than 5.5 mg/dL (327.14 μmol/L) were significant factors for the successful expectant management.

Introduction

Preeclampsia occurs in 4.6 % of pregnancies worldwide. This number is increasing every year and varies among different regions [1]. In Thailand, incidence of preeclampsia in 2017 was 19 per 1,000 deliveries, with severe preeclampsia or eclampsia diagnosed at 10.1 per 1,000 deliveries [2]. Preeclampsia is the leading cause of maternal mortality after postpartum hemorrhage at 10–15 % [3], [4]. Severe complications such as morbidity and perinatal mortality of the fetus also include abruption of the placenta, cerebral hemorrhage, coagulopathy and preterm birth [5], [6], [7]. In premature newborns, preeclampsia can lead to perinatal death and other complications [8]. Preeclampsia diagnosed early in pregnancy may result in premature delivery, with low birth weight requiring extended stay in the intensive care unit. These complications require extensive resources to care for this group of newborns.

Knowledge related to the management of hypertension in pregnancy is increasing. The American Association of Obstetricians and Gynecologists is continually modifying the diagnosis of preeclampsia to improve disease assessment and patient care guidelines [9]. Women diagnosed with early-onset severe features preeclampsia before 34 weeks of gestation require close observation for the benefit of the fetus [10].

This study determined the incidence and perinatal outcomes of complications in pregnant women with severe features preeclampsia diagnosed before 34 weeks of gestation with identified prognosis factors for successful expectant management.

Section snippetsMaterials and methods

A retrospective descriptive multicenter cohort study of pregnant women diagnosed with severe features preeclampsia before 34 weeks of gestation according to the American College of Obstetricians and Gynecologists (ACOG) guidelines was conducted at Khon Kaen University, Srinagarind Hospital and Khon Kaen Hospital between January 1, 2015 and December 31, 2019. Medical records were reviewed, and incomplete or lost data and fetal anomalies were excluded. Baseline characteristics were collected as

Results

From a total of 42,948 deliveries during the study period, 971 were diagnosed with severe features preeclampsia (22 per 1,000 deliveries). Two hundred and sixty-five women (6.3 per 1,000 deliveries) were diagnosed with early-onset severe features preeclampsia, as shown in Fig. 1.

Table 1 shows the characteristics of pregnant women with early-onset severe features preeclampsia. The mean age of pregnant women was 30.4 years old. Approximately half were nulliparous, with normal pre-pregnancy body

Discussion

Incidence of early-onset severe features preeclampsia in this study was 6.3 per 1,000 deliveries (95 % CI 5.578–7.098), showing an increase from a previous study at Srinagarind Hospital, Khon Kaen University in 2018 (4 per 1,000 deliveries) [11] and concurring with Wang et al. [12] (2021) who recorded that incidence of hypertensive disorder in pregnancy increased 10.92 % from 1990 to 2019 globally. No significant differences were found in characteristics of the expectant and delivery management

Conclusion

Incidence of early-onset severe features preeclampsia was 6.3 per 1,000 deliveries. For women suffering complications from early-onset severe features preeclampsia, expectant management may benefit perinatal outcomes without differences in maternal complications compared to immediate delivery management. The gestational age at diagnosis of more than 30 weeks and uric acid level of less than 5.5 mg/dL (327.14 μmol/L) were prognosis factors for successful expectant management.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We would like to thank the staff at Srinagarind Hospital and Khon Kaen Hospital for their assistance.

References (17)

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© 2022 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

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