Abstract
Objective This study aimed to characterize rates of maternal morbidity associated with early
(<34 wk) preeclampsia with severe features and to determine factors associated with
developing these morbidities.
Study Design Retrospective cohort study of patients with early preeclampsia with severe features
at a single institution from 2013 to 2019. Inclusion criteria were admission between
23 and 34 weeks and diagnosis of preeclampsia with severe features. Maternal morbidity
defined as death, sepsis, intensive care unit (ICU) admission, acute renal insufficiency
(acute kidney injury [AKI]), postpartum (PP) dilation and curettage, PP hysterectomy,
venous thromboembolism (VTE), PP hemorrhage (PPH), PP wound infection, PP endometritis,
pelvic abscess, PP pneumonia, readmission, and/or need for blood transfusion. Death,
ICU admission, VTE, AKI, PP hysterectomy, sepsis, and/or transfusion of >2 units were
considered severe maternal morbidity (SMM). Simple statistics used to compare characteristics
among patients experiencing any morbidity and those not. Poisson regression used to
assess relative risks.
Results Of 260 patients included, 77 (29.6%) experienced maternal morbidity and 16 (6.2%)
experienced severe morbidity. PPH (n = 46, 17.7%) was the most common morbidity, although 15 (5.8%) patients were readmitted,
16 (6.2%) needed a blood transfusion, and 14 (5.4%) had AKI. Patients who experienced
maternal morbidity were more likely to be advanced maternal age, have preexisting
diabetes, have multiples, and deliver nonvaginally (all ps < 0.05). Diagnosis of preeclampsia < 28 weeks or longer latency from diagnosis to
delivery were not associated with increased maternal morbidity. In regression models,
the relative risk of maternal morbidity remained significant for twins (adjusted odds
ration [aOR]: 2.57; 95% confidence interval [CI]: 1.67, 3.96) and preexisting diabetes
(aOR: 1.64; 95% CI: 1.04, 2.58), whereas attempted vaginal delivery was protective
(aOR: 0.53; 95% CI: 0.30, 0.92).
Conclusion In this cohort, more than 1 in 4 patients diagnosed with early preeclampsia with
severe features experienced maternal morbidity, whereas 1 in 16 patients experienced
SMM. Twins and pregestational diabetes were associated with higher risk of morbidity,
whereas attempted vaginal delivery was protective. These data may be helpful in promoting
risk reduction and counseling patients diagnosed with early preeclampsia with severe
features.
Key Points
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One in four patients diagnosed with preeclampsia w/ severe features experienced maternal
morbidity.
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One in 16 patients with preeclampsia w/ severe features experienced severe maternal
morbidity.
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Factors most associated with morbidity/severe morbidity were twins and pregestational
diabetes.
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Patients who attempted vaginal delivery appeared to have a lower rate of morbidity.
Keywords
maternal morbidity - maternal mortality - preeclampsia - early preeclampsia with severe
features
