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Abstract

Objectives To study adverse outcomes associated with definitions of preeclampsia and compare them to patients not meeting diagnostic criteria for preeclampsia. Methods A multicenter, prospective, observational study was conducted on women with suspected preeclampsia (PE). Patients were managed by local protocol, and final diagnoses were adjudicated by independent panel. Subjects were classified as Traditional PE (TrPE) with both hypertension and proteinuria, or eclampsia or HELLP syndrome (ACOG 2012); Nonproteinuric PE (NpPE) with severe gestational hypertension (BP >160/110) or mild hypertension plus ⩾1 severe feature (ACOG, 2013); or No diagnosis (NoD). Adverse outcomes included preterm birth (PTB), SGA, IUFD, neonatal demise (NND), and severe maternal adverse outcomes (MAO - abruption, renal failure, pulmonary edema, fatty liver, TTP, DIC, stroke, and retinal detachment). Comparisons tested with Chi square, α = 0.05. Results A total of 757 subjects with signs or symptoms of PE were enrolled Table 1 ). 96 had chronic hypertension or mild gestational hypertension. As compared to TrPE, women with NpPE experienced similar rates of all adverse outcomes. Subjects with NoD also had similar rates of IUFD, NND, and MAO. However, women with NoD experienced lower rates of PTB p Conclusions Among patients with suspected preeclampsia before 35 weeks, the risks of severe adverse outcomes are elevated, even for those who fall outside current clinical diagnostic categories. Patients without a diagnosis, however have fewer preterm deliveries and SGA babies. Diagnostic criteria for preeclampsia poorly predict severe adverse outcomes, and may contribute to preterm delivery. Disclosures D. Woelkers: None. J. Barton: None. P. von Dadelszen: None. B. Sibai: None.