(450) Beyond Maternal Indications: Considering Fetal Risk in the Management of Severe Preeclampsia

Preeclampsia with severe features (PEC-SF) is a major cause of maternal and neonatal morbidity. We aimed to estimate the association between number of and individual severe features (SF) and perinatal morbidity.

Study Design:
We conducted a retrospective cohort study of patients diagnosed with PEC-SF who delivered at two tertiary academic medical centers between 12/2015 and 12/2017. Patients were identified using ICD-10 codes, and clinical data were abstracted through chart review. The primary exposure was the number of SF present at diagnosis, while secondary analyses assessed the association between specific SF, as defined by ACOG criteria, and perinatal outcomes, including gestational age (GA) at delivery, mode of delivery, small for gestational age (SGA), placental abruption, and intrauterine fetal demise (IUFD).

Results:

773 patients met criteria for PEC-SF. Of these, 411 (53.2%) had one SF, 273 (35.3%) had two, 65 (8.4%) had three, and 24 (3.1%) had four to six SF. Increasing number of SF was significantly associated with earlier GA at delivery, both scheduled and intrapartum cesarean delivery (CD), and IUFD (Table 1). SGA also occurred most often in neonates born to patients with 4–6 SF (p=0.04). By individual SF criteria, pulmonary edema had the highest proportion of adverse perinatal outcomes: 50% of neonates were delivered < 34 weeks, and mothers with pulmonary edema had the highest rates of placental abruption and IUFD. CD rates were high across all subtypes (38–56%), with the highest intrapartum CD rate observed in patients with renal dysfunction. SGA was most prevalent among patients with thrombocytopenia (Table 2).

Conclusion:

Although the presence of more than three severe features typically necessitates delivery for maternal indications, our findings demonstrate this level of disease severity also carries substantial fetal risk—particularly heightened likelihood of intrauterine fetal demise.