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Hypertension

Poster Session 2

(405) Expectant management of Early Onset Preeclampsia with Severe Features Before 24 weeks

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

The recent ACOG practice bulletin offers no guidance on management of early onset severe preeclampsia (PreE) before 24 weeks (wks). Historically, delivery was recommended due to poor perinatal outcomes and risk of maternal morbidity. An increase in maternal age, medical co-morbidities, and advances in neonatal resuscitation have led to more cases of early onset severe PreE with the possibility of expectant management at gestational ages below the limit of viability. We aimed to report perinatal and maternal outcomes after expectant management of severe PreE < 24 wks to assist in counseling and shared decision making.

Study Design:

A retrospective case series of individuals with severe PreE at < 24 wks gestation managed at a Level IV center between 2017-2022. Individuals requiring delivery within 24 hours of diagnosis were excluded. Perinatal and maternal outcomes were abstracted from electronic medical records.

Results:

Of 27,626 births during the study period, 51 (0.2%) had severe PreE < 24 wks and 9 (18%) were excluded due to delivery < 24 hours. Among 42 undergoing expectant management, the median gestational age of diagnosis was 23 wks. 55% had chronic hypertension, 33% had PreE in a prior pregnancy, and 71% had a BMI >30 kg/m2. There was one surviving neonate when PreE developed at < 22 wks. Neonatal survival was highest at 22-23 wks (43%; 95%CI 21-67% and 58%; 95%CI 36-77%, respectively). Median latency at 22 and 23 wks was 6 (range 1-38) and 4 days (range 1-46), respectively. Median NICU stay at 22 and 23 wks was 124 (range 15-271) and 88 days (range 2-151), respectively. The most common indication for delivery was uncontrolled hypertension (49%). Adverse maternal outcomes were rare, the most common being transient renal insufficiency (7%; 95%CI 2-19%) and pulmonary edema (7%; 95% CI 2-19%) (Table 1).

Conclusion:

Our findings suggest that perinatal survival is markedly improved during expectant management of severe PreE at 22-23 weeks with minimal increase in maternal morbidity. This information should be available when counseling individuals on expectant management of severe PreE < 24 weeks.