Delayed versus early delivery leads to similar outcome in selected cases of preeclampsia in the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort

Katja Kivisilta; Elli Toivonen; Aaron Kiverä; Eija Kortelainen; FINNPEC Core Investigator Group; Jukka Uotila; Hannele Laivuori

doi:10.1016/j.preghy.2024.101129

Delayed versus early delivery leads to similar outcome in selected cases of preeclampsia in the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort

Pregnancy Hypertens. 2024 May 8:36:101129. doi: 10.1016/j.preghy.2024.101129. Online ahead of print.

Authors

Katja Kivisilta¹, Elli Toivonen², Aaron Kiverä³, Eija Kortelainen⁴; FINNPEC Core Investigator Group; Jukka Uotila⁵, Hannele Laivuori⁶

Affiliations

¹ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Arvo Ylpön katu 34, 33520 Tampere, Finland. Electronic address: katja.kivisilta@tuni.fi.
² Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Finland, P.O. Box 2000, 33521 Tampere, Finland. Electronic address: elli.toivonen@tuni.fi.
³ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Arvo Ylpön katu 34, 33520 Tampere, Finland. Electronic address: aaron.kivera@helsinki.fi.
⁴ Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, P.O. Box 63 FI-00014, University of Helsinki, Finland; Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, Haartmaninkatu 8, Helsinki 00029 HUS, Finland. Electronic address: eija.kortelainen@helsinki.fi.
⁵ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Finland, P.O. Box 2000, 33521 Tampere, Finland. Electronic address: jukka.uotila@fimnet.fi.
⁶ Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Arvo Ylpön katu 34, 33520 Tampere, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Finland, P.O. Box 2000, 33521 Tampere, Finland; Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland, P.O. Box 63 FI-00014, University of Helsinki, Finland; Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki Finland, P.O. Box 20 FI-00014, University of Helsinki, Finland. Electronic address: hannele.laivuori@tuni.fi.

PMID: 38723338
DOI: 10.1016/j.preghy.2024.101129

Abstract

Objectives: Most guidelines recommend induction of labor after 37 weeks of gestation in preeclampsia. This study assessed the effect of interval between diagnosis of preeclampsia and delivery on maternal and perinatal outcomes.

Study design: A cohort of 1637 women with preeclampsia recruited at five university hospitals in Finland was studied. Outcomes were compared in two groups according to the time interval between diagnosis of PE and delivery: delivery in less than 10 days (the early delivery group) and delivery at 10 days or later after the diagnosis (the delayed delivery group).

Main outcome measures: Maternal outcomes included significantly preterm delivery (delivery before 34 weeks of gestation), placental abruption, eclampsia and maternal intensive care or intensive monitoring for more than 24 h. Neonatal outcomes included small for gestational age, Apgar score of less than seven at the age of five minutes, umbilical artery pH < 7.05 and fetal death.

Results: No differences in frequency of preterm deliveries or maternal need for intensive care were observed between groups. Eclampsia and fetal death were rare, and their incidence did not differ between the groups. No maternal deaths were observed. Low Apgar score at five minutes of age was reported more commonly in the early delivery group, but there was no difference in fetal acidemia between groups.

Conclusion: Early and delayed delivery lead to comparable outcomes in this cohort. Expectant management could be beneficial in women with an unripe cervix or preterm preeclampsia without severe features.

Keywords: Expectant management; HELLP; Hypertension; Preeclampsia; Pregnancy; Superimposed preeclampsia.