Maternal and neonatal outcomes in women with severe early onset pre‐eclampsia before 26 weeks of gestation, a case series

摘要

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.