39 Changes in management of pre-eclampsia between two time periods at the BC Women’s Hospital, Vancouver

Abstract

Introduction The fullPIERS model, which predicts adverse maternal outcomes in women with pre-eclampsia, was developed in 2010 in a cohort of 2023 women in high-resourced settings. The model was internally validated and had a good discrimination with an area under the receiver-operating characteristic curve of 0.88 (95%CI 0.84–0.92). Re-evaluating the model performance in the same setting at a later time (temporal validation) is necessary to ensure its clinical utility. Before temporally validating the model, it is useful to examine any changes in population characteristics and clinical management over time as these will give useful information on the potential performance of the model. Objective To compare changes in risk of pre-eclampsia, adverse maternal and neonatal outcomes and management in one of the development settings (British Columbia (BC) Women's Hospital, Vancouver), between the time period prior to the fullPIERS model development (development data) and after the model development (temporal data). Methods Our study population included 1071 women admitted to the BC Women's hospital from 2003 to 2010 included in the model development, and 545 women admitted with pre-eclampsia in the same centre from 2012 to 2014. The demographic characteristics, management of pre-eclampsia and rates of adverse outcomes of the development and temporal data were compared using χ 2 and Mann Whitney test statistics. Results The women in the temporal cohort were more likely to be older, multiparous and had a later onset of pre-eclampsia compared with the development cohort (Table 1). The rate of adverse maternal outcomes within 48h of admission in the temporal data was 4.2% similar to the development data (4.7%). There were no significant differences in the rates of adverse perinatal outcomes. Regarding the treatment and management of pre-eclampsia, the rate of administration of antihypertensive medication and MgSO 4 did not differ between the two groups. However, women in the temporal data were more likely to have a shorter admission-to-delivery interval compared with the development cohort. Conclusion Overall, there was no significant change in the management of pre-eclampsia and outcome rate in the hospital over the time periods studied. However, there were some significant differences in the demographics and signs of the women between the development and temporal data. Therefore, it is important to investigate if and how these changes could affect the fullPIERS model performance on temporal validation.