(615) Expectant management of preeclampsia with severe features: clinical outcomes based on severe features at diagnosis

To evaluate latency and clinical outcomes based on severe features present at diagnosis among patients with preeclampsia with severe features (SPEC) who were expectantly managed.

Study Design:

Retrospective cohort study from two hospitals within our academic institution including patients diagnosed with SPEC between 24 0/7-33 6/7 weeks from 2015-2019. Patients were included if expectantly managed and excluded if delivery was planned immediately or following steroid administration. We compared outcomes based on severe features present at diagnosis.

Results:

220 of 407 deliveries (54%) complicated by SPEC were expectantly managed. Three groups were established based on severe features at diagnosis: Group 1: severe blood pressure (BP) alone n=145; Group 2: symptomatic (headache, visual disturbances, or right upper quadrant/epigastric pain; +/- severe BP, n=52); Group 3: lab abnormalities (elevated liver function tests 2x normal, low platelets < 100,000, or creatinine >1.1 mg/dL; +/- severe BP, n=23). Fetal growth restriction was least likely in the lab abnormalities group (50% vs 61% vs 29%, p=0.01). The severe BP alone and lab abnormalities groups both had a median diagnosis-to-delivery interval of 3 days compared to 2 days among the symptomatic group (p=0.02). 43 (20%) had a latency of ≥7 days. Only 13 (6%) achieved 34 weeks. Indications for delivery differed by group (p< 0.001). Maternal ICU admission was more common in the lab abnormality group (3% vs 4% vs 17%, p=0.007), and maternal length of stay was longer in the severe BP alone group (8 vs 7 vs 6 days, p=0.004). Neonatal outcomes evaluated did not differ significantly.

Conclusion: In our cohort, the time from diagnosis of SPEC to delivery was 2-3 days depending on the severe features present at diagnosis, and only 6% reached 34 weeks. Indications for delivery differed by severe features present at diagnosis. Maternal ICU admission was more common among patients with lab abnormalities, and maternal length of stay was slightly longer for women with severe BP alone. Other clinical outcomes studied did not differ substantially.