O66. Comparison of immediate delivery versus expectant management in women with severe early onset preeclampsia before 26 weeks of gestation

Abstract

Introduction Severe early onset preeclampsia (PE) is a rare pregnancy disorder with a high maternal and neonatal mortality and morbidity. At an extremely premature gestational age, severe preeclampsia is rare. It causes a distinctive dilemma, as foetal and maternal interests conflict. Prolongation of pregnancy (expectant management) may improve foetal prognosis on one hand, but increases maternal risks of severe morbidity and mortality on the other hand. Objectives To compare maternal and neonatal outcomes of immediate delivery or expectant management in women with severe, early onset preeclampsia before 26 weeks’ gestation. Methods We conducted a nationwide retrospective cohort study. We included women diagnosed with severe preeclampsia, who delivered between 22 and 26 weeks’ gestation in all tertiary perinatal care centres in the Netherlands between 2008 and 2014. Patients were identified through computerized hospital databases. We collected data using the medical records. Maternal complications, neonatal mortality and neonatal complications were the primary outcomes. Results We studied 133 women, of whom 99 (74%) were managed expectantly, while 34 women (26%) were treated with immediate delivery. Time interval between admittance and delivery was 4 days longer in the expectant group (6 versus 2 days, 95%CI 2.45–5.55). Expectant management was less often associated with perinatal death than immediate delivery (50% versus 88%; OR: 0.079, 95%CI: 0.02–0.37), but no differences were found for maternal (69% versus 68%; OR: 3.1, 95%CI: 0.22–44) or neonatal complications (81% versus 80%; OR: 3.3, 95%CI: 0.068–159). In 46 reported ongoing subsequent pregnancies, 17 (37%) women had recurrent preeclampsia. While no evident trend over time can be found in management or neonatal survival over the study period, a peak appears in caesarean section rate in 2011 and the occurrence of maternal complications seem to decrease. Conclusion In women with severe, early onset preeclampsia, expectant care was often applied in the Netherlands. The maternal complication rate is high. Therefore, women need to be counselled carefully, weighing expectant care versus high perinatal mortality in case of immediate delivery.