Amy M Valent1, Emily A DeFranco2, Allessa Allison3, Ahmed Salem4, Lori Klarquist4, Kyle Gonzales5, Mounira Habli6, C David Adair5, Casey Armistead3, Yuping Wang7, David Lewis3, Baha Sibai8. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati School of Medicine, Cincinnati, OH. Electronic address: miyoshay@ucmail.uc.edu. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati School of Medicine, Cincinnati, OH; Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Alabama Children's and Women's Hospital, Mobile, AL. 4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH. 5. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN. 6. Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH. 7. Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, LA. 8. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health, University of Texas, Houston, TX.
Abstract
OBJECTIVE: We sought to compare maternal and neonatal outcomes of expectantly managed pregnancies complicated by chronic hypertension with superimposed preeclampsia vs mild preeclampsia up to 37 weeks of gestation. STUDY DESIGN: This was a multicenter retrospective cohort study of all pregnancies complicated by chronic hypertension with superimposed preeclampsia or mild preeclampsia expectantly managed in the hospital from January 2008 through December 2011. The primary outcomes, adverse maternal and neonatal composite morbidities, were compared between these 2 groups. Frequency differences of maternal adverse outcomes were stratified by gestational age at delivery of <34 and 34-36(6/7) weeks of gestation. RESULTS: We found no significant differences in rates of neonatal composite morbidity or latency periods between women with superimposed preeclampsia and mild preeclampsia. Adverse neonatal outcomes were significantly higher at <34 compared to 34-36(6/7) weeks of gestation (97-98% vs 48-50%) in both cohorts. Maternal adverse composite outcome occurred more frequently in women with superimposed preeclampsia compared to mild preeclampsia (15% vs 5%; P = .003; relative risk, 3.0; 95% confidence interval, 1.45-6.29). CONCLUSION: Women with superimposed preeclampsia have similar neonatal outcomes but more maternal complications than women with preeclampsia without severe features who are expectantly managed <37 weeks.
OBJECTIVE: We sought to compare maternal and neonatal outcomes of expectantly managed pregnancies complicated by chronic hypertension with superimposed preeclampsia vs mild preeclampsia up to 37 weeks of gestation. STUDY DESIGN: This was a multicenter retrospective cohort study of all pregnancies complicated by chronic hypertension with superimposed preeclampsia or mild preeclampsia expectantly managed in the hospital from January 2008 through December 2011. The primary outcomes, adverse maternal and neonatal composite morbidities, were compared between these 2 groups. Frequency differences of maternal adverse outcomes were stratified by gestational age at delivery of <34 and 34-36(6/7) weeks of gestation. RESULTS: We found no significant differences in rates of neonatal composite morbidity or latency periods between women with superimposed preeclampsia and mild preeclampsia. Adverse neonatal outcomes were significantly higher at <34 compared to 34-36(6/7) weeks of gestation (97-98% vs 48-50%) in both cohorts. Maternal adverse composite outcome occurred more frequently in women with superimposed preeclampsia compared to mild preeclampsia (15% vs 5%; P = .003; relative risk, 3.0; 95% confidence interval, 1.45-6.29). CONCLUSION:Women with superimposed preeclampsia have similar neonatal outcomes but more maternal complications than women with preeclampsia without severe features who are expectantly managed <37 weeks.
Authors: Joshua I Rosenbloom; Adam K Lewkowitz; Kathryn J Lindley; D Michael Nelson; George A Macones; Alison G Cahill; Margaret A Olsen; Molly J Stout Journal: Obstet Gynecol Date: 2020-01 Impact factor: 7.623
Authors: John A Morgan; Lauren E McCalmont; Craig V Towers; Melissa Davis; Miriam Hankins; Niyati Rangnekar; Mary Ellen McNeal; David F Lewis Journal: AJP Rep Date: 2020-03-04