504 Fetal growth restriction and latency from diagnosis to delivery in early onset preeclampsia

Abstract

Early onset preeclampsia (PE) is associated with increased maternal and neonatal morbidity, including fetal growth restriction (FGR). Data on the benefit of expectant management in women with early onset PE with severe features (SF) in the setting of FGR are limited. Therefore, we aimed to determine whether FGR shortens the latency from PE diagnosis till delivery, in women undergoing expectant management of early onset PE with SF. Retrospective chart review of women with early onset PE with SF that developed < 34 weeks of gestation, who delivered at a single tertiary care center between 2011-2020. Women were excluded if delivery was planned after completion of antenatal corticosteroids, fetal demise at time of PE diagnosis or fetal anomaly. Our primary outcome was latency from diagnosis of PE to delivery. Sub-analysis was performed to further evaluate the FGR group based on estimated fetal weight (EFW) ≤3% or abnormal Doppler studies defined as >95% systolic/diastolic umbilical artery Doppler (UAD) flow, absent or reversed UAD. Of 261 patients identified, 236 patients met criteria for analysis, with 80 (33.6%) FGR and 156 (66.4%) appropriately grown for gestational age (AGA) fetuses. There were no differences in maternal age, BMI at time of delivery, ethnicity/race, nulliparity, chronic hypertension or need for acute anti-hypertensive therapy. Patients with FGR were more likely to use tobacco and be delivered via cesarean compared with those with AGA fetuses. Pregnancies complicated by FGR were diagnosed with PE and delivered at earlier GA compared with those with AGA fetuses. (Table 1) There were no differences in latency between the two groups with median of 3 [IQR 1-5] vs 2 [1-4] days. There were no differences in the composites of maternal or neonatal outcomes. Similar patterns were observed in sub-analysis of FGR by EFW ≤3% and abnormal UAD studies. (Table 2) In patients with early onset PE with SF, FGR did not impact latency or worsen short term maternal and neonatal outcomes. Further research is needed to determine long term maternal and child outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)