Oral Concurrent Session 8 - Hypertension
Oral Concurrent Sessions
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Zakaria Doughan, MD
Research Assistant
Department of Obstetrics and Gynecology, McGovern Medical School at UT Health, Houston
Houston, Texas, United States
Yossi Bart, MD
MFM fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Joe Haydamous, MD (he/him/his)
PGY1
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Department of Obstetrics and Gynecology, McGovern Medical School at UT Health, Houston, Texas, United States
Wissam Akkary, MD
Maternal-Fetal Medicine Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Ahmed Zaki Moustafa, MD, MS (he/him/his)
Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
University of Texas - Houston, Texas, United States
Baha M. Sibai, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Current guidelines lack clear recommendations on the optimal frequency of serial lab testing during expectant management of severe preeclampsia. This study aimed to describe the effect of serial laboratory tests on clinical decision-making and the cost per patient.
Study Design:
A retrospective study of singletons diagnosed with preeclampsia with severe features between 23w0d and 33w3d (2016–2025), conducted at a single quaternary care center. Patients were excluded if they delivered within one day of admission or had contraindications for expectant management on presentation (eclampsia, HELLP syndrome, stroke, AKI, pulmonary edema, IUFD, and abruption). For each patient, we recorded the number of tests until delivery and associated costs based on institutional pricing. The primary outcome was the proportion of deliveries prompted by abnormal tests. Secondary outcomes included total and average lab-related cost per patient.
Results:
A total of 370 patients met inclusion criteria. The median number of tests per patient was 4 (IQR 3–7), with labs drawn on average every 1.6 days (±2.4). The average cost of serial labs per admission was $5,055 (±$3,893), with a median of $4,024 (IQR $2,094–$6,423), totaling $1.87 million over 10 years. Eleven patients (3%) were delivered solely due to abnormal tests; all delivered within 4 days of diagnosis (mean 2.4 ± 1.4 days), and most (6/11) had abnormal labs at presentation that worsened by the time of delivery (Figure 1). Additional 19 patients (5%) had lab abnormalities plus other indications for delivery, most commonly uncontrolled hypertension (11/19), and had longer latency to delivery (mean 7.7 ± 6.6 days; P=0.003).
Conclusion:
In this cohort of expectantly managed patients with preeclampsia with severe features before 34 weeks, only 3% were delivered solely for abnormal labs, all within 4 days of diagnosis. Most patients with eventual lab abnormalities on serial draws had other concomitant delivery indications. These findings suggest that frequent lab testing may have limited impact on clinical decision-making and should be weighed against its associated cost.