Expectant management of severe preterm preeclampsia: a comparison of maternal and fetal indications for delivery

Abstract

Objective: To examine the delivery indication (maternal or fetal) for patients with preterm preeclampsia and assess whether disease characteristics at presentation are predictive of delivery indication.

Methods: We conducted a retrospective cohort study at a tertiary hospital in Melbourne, Australia (Mercy Hospital for Women). We assessed indication for delivery for participants presenting with preeclampsia from 23⁺⁰ to 32⁺⁶ weeks gestation. We compared baseline disease characteristics, disease features at delivery and postnatal outcomes between those delivered for maternal or fetal indications, or for both maternal and fetal indications.

Results: Two hundred sixty six participants presented with preterm preeclampsia and 108 were eligible for inclusion in our study. More participants were delivered for maternal indications at 65.7% compared to those requiring delivery on fetal grounds at 19.4% or for both indications at 14.8% (p < 0.0001). Maternal disease characteristics at presentation were similar between groups; however, there was a higher proportion of growth restriction and abnormal Dopplers among those delivered on fetal grounds. Participants delivered on maternal grounds gained less gestation, had higher blood pressure and higher incidence of abnormal liver function tests than those delivering for fetal indications at delivery.

Conclusion: Participants with preterm preeclampsia were predominantly delivered due to maternal disease progression compared to fetal compromise.

• Delivery indication
• fetal morbidity
• maternal morbidity
• preterm preeclampsia
• therapeutics

Acknowledgements

We would like to thank the patients at Mercy Hospital for Women for participating in this research.

Declaration of interest

F.B. was supported by an Australian Postgraduate Award, an AVANT scholarship, an Arthur Wilson Memorial Scholarship and by the Medical Research Foundation for Women and Babies. S.T. was supported by the National Health and Medical Research Council of Australia [#10 50765]. The funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.