Expectant management of preeclampsia superimposed on chronic hypertension

Abstract

Objective. Women with chronic hypertension (CHTN) are at an increased risk for pregnancy complications including preeclampsia. The objective of this study was to review pregnancy outcomes for women with expectant management of preeclampsia superimposed on CHTN prior to 37 weeks'.Methods. We reviewed the inpatient charts of all women admitted to Magee-Womens Hospital (1995–2005) with the diagnosis of both CHTN and preeclampsia prior to term.Results. Sixty-eight women diagnosed with both CHTN and preeclampsia prior to 37 weeks' were identified. Of these, 42 women were expectantly managed; one subject was excluded from analysis for pregestational diabetes. For the remaining 41 women, the median gestational age at diagnosis was 31.6 weeks (range 23.6–36.4). The mean time from diagnosis to delivery was 9.7 days (range 2–34 days). Adverse perinatal outcomes included one case of HELLP syndrome, two cases of placental abruptions, three cases of pulmonary edema, and five postpartum hemorrhages. There were no fetal/neonatal or maternal deaths. Average NICU stay was 17.9 days.Conclusions. Expectant management of preterm superimposed preeclampsia among women with CHTN is a reasonable management strategy, but associated with some maternal morbidity. Prospective studies are needed to definitively quantify the risks and benefits of this approach.