(204) Maternal outcomes differ by preeclampsia with severe features subtype

Preeclampsia (PEC) is associated with major maternal morbidity. Up to 43% with PEC have >1 qualifying criteria for severe features. Although ACOG defines criteria for PEC with severe features (PEC-SF), the frequency of each severe criterion and the association of different criteria on adverse maternal outcomes is unknown. We aimed to estimate the association between defining criteria of PEC-SF with immediate severe maternal morbidity (SMM).

Study Design:

Retrospective cohort study of patients with PEC-SF who delivered at two centers from 12/2015 to 12/2017. Patients were identified via ICD-10 codes and chart abstraction was done. PEC-SF was defined per ACOG guidelines. Our primary outcome was CDC-defined SMM (MI, aneurysm, renal failure, ARDS, AFE, VFib, cardioversion, DIC, transfusion, eclampsia, CHF, CVA, anesthetic complications, sepsis, shock, sickle crisis, pulmonary edema, air/thrombotic embolism, hysterectomy, tracheostomy, and/or ventilation) during the delivery hospitalization. Our secondary outcome was SMM at 1 year postpartum (PP). Using multiple regression, adjusting for maternal BMI > 30 kg/m², preexisting CHTN, diabetes, and/or renal insufficiency, we report aOR (95% CI) to estimate the association between each criterion and SMM at the 2 time points.

Results:

774 patients were analyzed. Severe HTN (85.4%) and headache (34.9%) were the most common criteria (Figure 1). SMM occurred at delivery hospitalization in 95 (12.3%) and within 1 year PP in 30 (3.9%). Blood pressure and headache were least likely to be present in patients with SMM at delivery (Figure 2). Thrombocytopenia [aOR 1.3 (1.2-1.4)], renal dysfunction [aOR 1.4 (1.3-1.6)], and pulmonary edema [aOR 1.9 (1.6-2.1)] were associated with SMM at delivery, and liver dysfunction [aOR 0.9 (0.9-1.0)] was protective. There were no significant associations between criteria and SMM within 1 year PP.

Conclusion:

More than 10% of patients with PEC-SF have an SMM at delivery hospitalization and those with thrombocytopenia, kidney dysfunction, or pulmonary edema as severe criteria should be delivered at hospitals equipped to manage SMM.