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 - van Runnard Heimel, P.
AU - Scheepers, H. C.J.
AU - Ganzevoort, W.
AU - Mol, B. W.J.
AU - de Groot, C. J.
AU - Gaugler-Senden, I. P.M.
N1 - Publisher Copyright:
© 2017 Royal College of Obstetricians and Gynaecologists
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. Tweetable abstract: Severe early onset pre-eclampsia comes with high maternal complication rates and poor neonatal survival.
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. Tweetable abstract: Severe early onset pre-eclampsia comes with high maternal complication rates and poor neonatal survival.
KW - Maternal and neonatal outcome
KW - preterm birth
KW - prolongation
KW - severe pre-eclampsia
UR - https://www.scopus.com/pages/publications/85011320838
U2 - 10.1111/1471-0528.14512
DO - 10.1111/1471-0528.14512
M3 - Article
AN - SCOPUS:85011320838
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 -