Assessing progression from mild to severe preeclampsia in expectantly managed preterm parturients

Abstract

Objective: To identify factors associated with shortened latency in expectantly managed women diagnosed with preeclampsia without severe features between 23 0/7 and 35 6/7weeks' gestation.

Methods: This was a retrospective cohort study performed at a large community-based hospital between 2009 and 2014, evaluating all mothers between 23 0/7 and 35 6/7weeks' gestation with a diagnosis of preeclampsia without severe features. We collected maternal demographics, symptoms, vital signs and laboratory values within six hours of admission. Maternal and neonatal outcomes were stratified by latency period of less than or greater than/equal to seven days (<7d or ⩾7d).

Results: Overall mean latency was 7.6±12.1days. When stratifying subjects to <7d or ⩾7d latency, neither maternal demographics nor gestational age at diagnosis differed between groups. For subjects with ⩾7d latency, pregnancy was prolonged by a mean of 24days compared to the <7d latency group (34 1/7 vs 30 4/7weeks GA, P=0.001). Systolic blood pressure greater than 160mmHg within the first six hours of hospital presentation correlated with a more than 3-fold risk for requiring delivery within seven days of diagnosis (OR 3.26 95% CI 1.40-7.58).

Conclusion: Within our cohort of preterm women admitted with preeclampsia without severe features, elevated systolic blood pressure on admission conveyed significant risk for delivery within seven days.

Keywords: Expectant management; Hypertension; Latency period; Preeclampsia; Systolic blood pressure.