Is neonatal adverse neurological outcome or death predictable at admission of women with early preterm hypertensive disorders of pregnancy?

Abstract

ADMISSION OF WOMEN WITH EARLY PRETERM HYPERTENSIVE DISORDERS OF PREGNANCY? ANNELIES REP, WESSEL GANZEVOORT, LAILA DE GROOT, HANNEKE DE VRIES, GOUKE BONSEL, HANS WOLF, VU University Medical Center, Amsterdam, Netherlands, Academisch Medisch Centrum, Amsterdam, Netherlands, Academic Medical Center, Amsterdam, Netherlands, Amsterdam, Netherlands, Academisch Medisch Centrum Amsterdam, Obstetrics, Amsterdam, Netherlands OBJECTIVE: To assess if abnormal neonatal neurological outcome or death can be predicted by clinical parameters at admission for early preterm hypertensive disorders of pregnancy. STUDY DESIGN: 216 patients with hypertension-related complications of pregnancy and gestational age 24-34 weeks were randomized for temporizing management with plasma volume expansion (n = 111; 250 ml HydroxyEthylStarch 6% twice daily in 4 hours) or without (n = 105). Primary endpoints of the study were a neurological optimality score of the neonate at term age, defined as normal, suspect or abnormal (Prechtl), and perinatal mortality. Adverse Infant Outcome (AIO) was defined as an abnormal neurological score or death. The influence of demographic and clinical factors (age, parity, ethnicity, BMI, gestational age, estimated fetal weight, blood pressure, hemoglobin count, diagnosis and treatment allocation at inclusion, and 3 months post term chronic hypertension, renal morbidity (proteinuria >0.5 g/24 hours or creatinine clearance !90 mL/min/1.73m) and haemostatic abnormalities) on AIO was assessed by multivariate analysis. RESULTS: In the treatment group 79 (71%) infants survived with normal/ suspect neurological score, 7 (6%) infants had an abnormal score, 23 (21%) infants died (one of these had an abnormal score) and 3 were not examined (one refusal, one due to morbidity and one due to restlessness ). In the control group 87 (83%) survived with normal/suspect score, 3 (3%) had abnormal score, and 15 (14%) died. AIO occurred in 29% vs 17% (P= .1). Factors related to AIO were gestational age (OR 0.6; 95% CI 0.5-0.7 / week increase) and maternal renal morbidity (OR 0.2; 95% CI 0.0-0.9), and (not significant) plasma volume expansion treatment (OR 1.9; 95% CI 0.8-4.2). CONCLUSION: The most relevant factor related to AIO was gestational age on admission. Maternal admission diagnosis did not influence outcome. Women with renal morbidity appeared to have a better outcome when compared to the remaining women in the study group. Plasma volume expansion treatment might have an adverse effect on infant outcome.