M F van Oostwaard1, L van Eerden2, M W de Laat3, J J Duvekot4, Jjhm Erwich5, Kwm Bloemenkamp6, A C Bolte7, Jpf Bosma8, S V Koenen9, R F Kornelisse10, B Rethans3, P van Runnard Heimel11, Hcj Scheepers12, W Ganzevoort3, Bwj Mol13, C J de Groot14, Ipm Gaugler-Senden15. 1. Department of Obstetrics and Gynaecology, IJsselland Ziekenhuis, Capelle aan den Ijssel, the Netherlands. 2. Department of Obstetrics and Gynaecology, Maasstad Ziekenhuis, Rotterdam, the Netherlands. 3. Department of Obstetrics and Gynaecology, Academisch Medisch Centrum, Amsterdam, the Netherlands. 4. Department of Obstetrics and Gynaecology, Erasmus Medisch Centrum, Rotterdam, the Netherlands. 5. Department of Obstetrics and Gynaecology, Universitair Medisch Centrum Groningen, Groningen, the Netherlands. 6. Department of Obstetrics and Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands. 7. Department of Obstetrics and Gynaecology, Radboud Universitair Medisch Centrum, Nijmegen, the Netherlands. 8. Department of Obstetrics and Gynaecology, Isala Ziekenhuis, Zwolle, the Netherlands. 9. Department of Obstetrics and Gynaecology, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands. 10. Department of Paediatrics, Erasmus Medisch Centrum, Rotterdam, the Netherlands. 11. Department of Obstetrics and Gynaecology, Maxima Medisch Centrum, Veldhoven, the Netherlands. 12. Department of Obstetrics and Gynaecology, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands. 13. School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia. 14. Department of Obstetrics and Gynaecology, VU Universitair Medisch Centrum, Amsterdam, the Netherlands. 15. Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.
Abstract
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.
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.
Authors: Kartik K Venkatesh; Robert A Strauss; Daniel J Westreich; John M Thorp; David M Stamilio; Katherine L Grantz Journal: Pregnancy Hypertens Date: 2020-03-10 Impact factor: 2.899
Authors: Mariana A Carvalho; Lina Bejjani; Rossana P V Francisco; Elizabeth G Patino; Alexandre Vivanti; Fernanda S Batista; Marcelo Zugaib; Frédéric J Mercier; Lisandra S Bernardes; Alexandra Benachi Journal: PLoS One Date: 2021-02-03 Impact factor: 3.240