Risk Factors for Adverse Maternal Outcomes Among Patients with Severe Preeclampsia Before 34 Weeks.

Abstract

To characterize rates of maternal morbidity associated with early (<34 weeks) preeclampsia with severe features (esPREX), and to determine factors associated with developing these morbidities. Retrospective cohort study of patients with esPREX at a single institution from 2013-2019. Inclusion criteria were admission between 23-34 weeks and diagnosis of preeclampsia with severe features. Maternal morbidity defined as death, sepsis, ICU admission, acute renal insufficiency(AKI), postpartum(PP) dilation and curation(D&C), PP hysterectomy, venous thromboembolism(VTE), PP hemorrhage(PPH), PP wound infection, PP endometritis, pelvic abscess, PP pneumonia, readmission, and/or need for blood transfusion. Death, ICU admission, VTE, AKI, PP hysterectomy, sepsis, and/or transfusion of >2 units were considered severe maternal morbidity(SMM). Simple statistics used to compare characteristics among patients experiencing any morbidity and those not. Poisson regression used to assess relative risks. Of 260 patients included, 77(29.6%) experienced maternal morbidity and 16(6.2%) experienced SMM. PPH(n=46, 17.7%) was the most common morbidity, though 15(5.8%) patients were readmitted, 16(6.2%) needed a blood transfusion, and 14(5.4%) had AKI. Patients who experienced maternal morbidity were more likely to be advanced maternal age, have pre-existing diabetes, have multiparity, and deliver non-vaginally (all p<0.05). Diagnosis of pre-eclampsia < 28 weeks or longer latency from diagnosis to delivery were not associated with increased maternal morbidity. In regression models, the relative risk of maternal morbidity remained significant for twins(aRR 2.29;95%CI:1.59,3.30), and pre-existing diabetes(aOR 1.69;95%CI:1.09,2.63), while attempted vaginal delivery was protective (aOR 0.63;95%CI:0.42,0.94). In this cohort, more than 1 in 4 patients diagnosed with esPREX experienced maternal morbidity, while 1 in 16 patients experienced SMM. Twins and pre-gestational diabetes were associated with higher risk of morbidity, while attempted vaginal delivery was protective. These data may be helpful in promoting risk reduction and counseling patients diagnosed with esPREX.