Category: Hypertension
Poster Session IV
Delivery timing for severe pre-eclampsia (SPREX) requires a balance of maternal disease progression and fetal prematurity. We investigated maternal morbidity and obstetric outcomes associated with long latency (>7 days) to delivery among patients undergoing expectant management for SPREX.
Study Design: Retrospective cohort study of patients with SPREX diagnosed < 32 weeks’ gestational age (GA) admitted to a single tertiary center (2013-2019) who were candidates for expectant management by ACOG. Patients with contraindications to expectant management, including those with < 2 days of latency, were excluded. An upper threshold of 32 weeks’ GA at diagnosis allowed for latency. Patients with long latency (>7 days) were compared to those without long latency ( < 7 days). The primary outcome was composite maternal morbidity, comprised of maternal death, sepsis, ICU admission, acute renal insufficiency, postpartum dilation and curettage, readmission, postpartum hemorrhage, infection, hysterectomy, venous thromboembolism, and blood transfusion. We also considered demographic, antepartum and delivery outcomes. Bivariate statistics compared characteristics and logistic regression estimated adjusted relative risks with 95% confidence intervals.
Results: Of 165 pregnancies with SPREX diagnosed < 32 weeks, 70 (42%) had long latency. Pregnancies with long latency were more likely to have advanced maternal age (31% v 23%, p=0.007), earlier admission GA (27.6 weeks v 29.3 weeks p=0.005), pre-eclampsia diagnosis < 28 weeks (37% v 29%, p=0.004) and higher admission platelets (232 v 213, p=0.04). (Table 1) Composite maternal morbidity was not different between pregnancies with or without long latency in bivariate and logistic regression even after controlling for maternal age, platelets, and admission GA. (Table 2)
Conclusion:
Among patients undergoing expectant management of SPREX, maternal morbidity was not increased among those with latency >7 days to delivery when compared to those with latency < 7 days. These data can be used to counsel patients on expectant management, latency and obstetric outcomes in SPREX.
Carmen M. Avram, MD
Resident Physician PGY3
Department of Obstetrics and Gynecology, Duke University Medical Center
Durham, North Carolina, United States
Jacquelyn L. Dillon, MS
Medical Student
Duke University Hospital
Durham, North Carolina, United States
Ronan P. Sugrue, MBBCH, MPH (he/him/his)
MFM Fellow
Duke University Medical Center
Durham, North Carolina, United States
Matthew R. Grace, MD
Assistant Professor
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Sarahn M. Wheeler, MD
Vice Chair for Equity, Diversity and Inclusion, Director Duke Prematurity Prevention Program
Duke University Medical Center
Durham, North Carolina, United States
Sarah K. Dotters-Katz, MD
Assistant Professor
Duke University Medical Center
Durham, North Carolina, United States