(908) Maternal outcomes by mode of delivery among pregnant patients with eclampsia: a retrospective cohort study

Objective: For most patients with preeclampsia, cesarean delivery can be reserved for usual obstetric indications, but data are limited for patients with eclampsia. The goal of this study is to evaluate maternal outcomes by intended mode of delivery in patients with eclampsia.

Study Design: This retrospective cohort study used the Premier Healthcare Database. Patients delivered between 2016-2020 with a diagnosis of eclampsia prior to delivery were included. The primary analysis compared intended cesarean delivery (non-intrapartum cesarean) to intended vaginal delivery (vaginal delivery and intrapartum cesarean) using a target trial emulation strategy. The primary outcome was non-transfusion severe maternal morbidity (SMM). The secondary outcome was ICU admission. We performed two subgroup analyses evaluating outcomes by gestational age (< 28 weeks, 28-34 weeks, > 35 weeks) and history of cesarean delivery. Logistic regression models were used to compare outcomes.

Results: The cohort included 3,491 patients. Patients with eclampsia who underwent intended cesarean delivery had significantly increased rates of non-transfusion SMM (16.0% vs 9.4%, OR 1.81 [1.47, 2.23]) and ICU admission (27.8% vs 13.1%, OR 2.48 [2.07, 2.98]) compared to patients with a trial of labor (Figure 1). These results remained significant with adjustment for patient demographic and facility characteristics as well as comorbid diagnoses. There was evidence of effect measure modification noted based on gestational age at delivery and history of prior cesarean delivery – for the latter, patients with a history of prior cesarean delivery who underwent intended vaginal delivery had higher rates of both SMM and ICU admission than those undergoing planned cesarean delivery.

Conclusion:

While intended vaginal delivery is associated with decreased risk of non-transfusion SMM and ICU admission in patients with eclampsia, particularly if > 35 weeks, TOLAC is associated with increased morbidity in this population. These results speak to a personalized approach to delivery route planning in patients with eclampsia.