Neonatal outcome of extreme preterm delivery in pregnancies complicated by early onset preeclampsia, eclampsia and HELLP-syndrome

Objective:

To analyze neonatal outcome after extreme preterm delivery before 27 weeks of gestation in early-onset preeclampsia, eclampsia and HELLP-Syndrome.

Patients and Methods:

Maternal and neonatal outcome of 21 pregnancies complicated by preeclampsia (P), eclampsia (E) or/and HELLP-Syndrome (H) (Group P/E/H) were compared to the outcome of 45 normotensive women (control group, C) delivered between 23^rd and 27^th week of gestation at the Department of Obstetrics and Gynaecology, Medical University Graz. Exclusion criteria were premature rupture of membrane (PROM), intrauterine infection and twin pregnancy. Statistical analysis was performed by χ²-Square Test and the P < 0.05 was accepted as significant.

Results:

The P/E/H-group included 9 women with preeclampsia, 1 woman with eclampsia and 11 women with HELLP-Syndrome. Two of the pregnancies were terminated after IUFD and 4 children died several days after delivery (3 °/_oo). In the C group, there were 6 cases of IUFD and 11 children died several days after delivery (4 °/_oo), n.s.

IUGR occurred in 20 women (95%) of the P/E/H-group compared to one pregnancy (2%) in the C-group (p < 0.001).

All P/E/H women and 33 C women received betamethasone for lung maturation. 10 children from P/E/H (52,6%) and 15 children from C (38,5%), P < 0.01 had asphyxia, 17 P/E/H (94,5%) and 33 C (84%) IRDS, n.s., 4 P/E/H (22%) and 14 C (37,8%) PVL, P < 0.05, 7 P/E/H (39%) and 10 C (28,6%), IVH, n.s., 5 P/E/H (27,8%) and 4 C (10,8%) cerebral palsy, P < 0.05, and 7 P/E/H children (38,9%) and 26 C children (72,2%) neonatal sepsis, P < 0.05 (Tab. 1).

Tab. 1

	IUGR	IUFD	neonatal death	Asphyxia	IRDS	Sepsis/ infection	IVH	PVL	cerebral palsy	development delay
C-group	1 (2%)	6 (13%)	11 (24%)	15 (38,5%)	33 (84%)	26 (72,2%)	10 (28,6%)	14 (37,8%)	4 (10,8%)	5 (5,4%)
P/E/H-group	20 (95%)***	2 (9,5%) ns	4 (19%) ns	10 (52,6%)**	17 (94,5%) ns	7 (38,9%)*	7 (39%) ns	4 (22%)*	5 (27,8%)*	1 (7,10%) ns
Legend: * P < 0.05, ** P < 0.01. *** P < 0.001; ns = not significant, IUGR: intrauterine growth restriction, IUFD: intrauterine fetal death, IRDS: infant respiratory distress syndrome, IVH: intraventricular hemorrhage, PVL: periventricular leucomalacia.

Conclusion:

Children from P/E/H suffer more frequently from growth restriction, asphyxia and cerebral palsy than children after extreme preterm delivery for other reasons. The higher incidence of cerebral palsy could be due to the higher frequency of intrauterine asphyxia. Otherwise, the decreased incidence of sepsis is associated with less PVL in P/E/H.