TY - JOUR
T1 - Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation, a case series
AU - van Oostwaard, M. F.
AU - van Eerden, L.
AU - de Laat, M. W.
AU - Duvekot, J. J.
AU - Erwich, J. J. H. M.
AU - Bloemenkamp, K. W. M.
AU - Bolte, A. C.
AU - Bosma, J. P. F.
AU - Koenen, S. V.
AU - Kornelisse, R. F.
AU - Rethans, B.
AU - Heimel, P. van Runnard
AU - Scheepers, H. C. J.
AU - Ganzevoort, W.
AU - Mol, B. W. J.
AU - de Groot, C. J.
AU - Gaugler-Senden, I. P. M.
PY - 2017/8
Y1 - 2017/8
N2 - Objective To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation.Design Nationwide case series.Setting All Dutch tertiary perinatal care centres.Population All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014.Methods Women were identified through computerised hospital databases. Data were collected from medical records.Main outcome measures Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival).Results We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days.Conclusions Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling.
AB - Objective To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation.Design Nationwide case series.Setting All Dutch tertiary perinatal care centres.Population All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014.Methods Women were identified through computerised hospital databases. Data were collected from medical records.Main outcome measures Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival).Results We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days.Conclusions Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling.
KW - Maternal and neonatal outcome
KW - preterm birth
KW - prolongation
KW - severe pre-eclampsia
U2 - 10.1111/1471-0528.14512
DO - 10.1111/1471-0528.14512
M3 - Article
C2 - 28128518
SN - 1470-0328
VL - 124
SP - 1440
EP - 1447
JO - Bjog-an International Journal of Obstetrics and Gynaecology
JF - Bjog-an International Journal of Obstetrics and Gynaecology
IS - 9
ER -