315. Is longer admission to delivery for expectant management in Pre-eclampsia associated with increased risk of maternal outcomes?

Abstract

Introduction Gestational age (GA) of pre-eclampsia onset is of clinical importance and affects management. Expectant management has been recommended for preterm pre-eclampsia to improve perinatal outcomes. However, prolonged pregnancy could expose the mother to higher risk of adverse outcomes. Objective/hypothesis We sought to compare characteristics of women admitted with pre-eclampsia at different GAs and examine whether longer admission to delivery is associated with higher rates of adverse maternal outcomes. Methods Data used for this study were derived from the fullPIERS prediction model external validation cohort, which included 2427 women admitted with pre-eclampsia, diagnosed according to the SOGC. The data were collected from 2003 to 2016 from tertiary hospitals in Canada, United Kingdom, Finland and USA. Demographic characteristics, clinical management practices and rates of adverse outcomes for women admitted with preterm pre-eclampsia ((i) before 32 weeks, (ii) between 32 and 33+6 weeks and (iii) between 34 and 36+6 weeks) and were compared with (iv) term pre-eclampsia (> 37 weeks’ gestation). The odds of experiencing adverse maternal outcomes with increasing admission to delivery interval was calculated. Results Majority of the women (46.4%) had term pre-eclampsia (Table 1). In general, women with preterm pre- eclampsia appeared to be younger, have multiple pregnancies and more likely to smoke compared with term pre- eclampsia. Women with preterm pre-eclampsia were also more likely to be administered treatment (corticosteroids, Magnesium sulphate and antihypertensive therapy). Longer admission to delivery was associated with a higher rate of adverse outcomes (OR 1.02 (95%CI: 1.00–1.03) although this association was non-significant after adjusting for GA at admission (ORadj: 1.0 (95%CI: 0.98–1.01) as well other demographic factors. Discussion Our findings supports reports that women with early-onset pre-eclampsia have significantly worse maternal and perinatal outcomes despite receiving more interventions. However, the higher rates of maternal outcomes were not associated with longer admission to delivery interval.