1. PERINATAL OUTCOME IN PATIENTS WITH SEVERE PREECLAMPSIA DELIVERED BETWEEN 28 & 34 WEEKS GESTATION
A. Khan, V. R. N. Ramoutar, B. Bassaw
Department of Obstetrics and Gynaecology, Mt. Hope Maternity Hospital, Trinidad, West Indies
Past Medical History
Frequency (%)
No known medical history
74 (72.5)
Insulin Dependent DM
3 (2.9)
Pre-Eclampsia
9 (8.8)
Psychotic Disease (queried)
1 (1.0)
Pre-Eclampsia & Stillbirth
Pre-Eclampsia & C-Section
2 (2.0)
Pre-Eclampsia with 20 C-Section
Pre-Eclampsia with 20 Stillbirth
Previous Stillbirth
C-Section & Pregnancy Induced Hypertension
Chronic Hypertension
4 (3.9)
Total
102 (100.0)
Parameters
28-31 wks
(n=25)
31-34 wks
(n=75)
Average POG at Delivery (wks ±SEM)
29.87 ± 0.14
32.76 ± 0.11
Pre-Delivery Corticosteroids [n (%)]
22 (88.0)
58 (77.3)
Fetal Complications in Utero [n (%)]
13 (52.0)
51 (68.0)
Average TTD (wks ±SEM)
1.03 ± 0.25
1.05 ± 0.12
Caesarean Section [n (%)]
53 (70.7)
Spontaneous Vaginal Delivery [n (%)]
11 (44.0)
21 (28.0)
Stillbirths [n (%)]
7 (28.0)
13 (17.3)
AIMS
To assess and compare the perinatal outcome of babies delivered between 28 and 34 weeks in mothers with severe preeclampsia in a tertiary institution
BACKGROUND
Table 1 (left): Breakdown of the frequencies of Past Medical Conditions amongst patients included in the study (N=102)
Table 2 (above): A comparison of several parameters between the patients delivering at wks and those delivering at wks (N=100, POG at delivery unknown for 2 patients)
Studies have shown that poor perinatal (from the 28th wk prior to delivery till 7 days post delivery) outcome associated with severe preeclampsia is related to prematurity rather than preeclampsia.
TTD, In Utero Complications and Stillbirths:
The average Time Till Delivery (TTD) for the patients in the study (N=100, since 2 POG values were unknown) was 1.04 ± 0.11 weeks with a range of 0.00 – 5.29 weeks. For the purposes of data analysis TTD was categorized into 3 groups: < 0.5 wk (n=35), wk (n=19) and > 1.0 wk (n=27). Table (above right) demonstrates the frequency of in utero complications and stillbirths amongst these three groups. (In utero complications included Intra-uterine Demise & Growth Restriction, Abnormal NST, and Oligohydramnios)
Figure 4 (below right) is a graphical representation of the increasing frequency of in utero complications as TTD increases (p=0.524).
METHOD
Frequency of:
n(%)
< 0.5 wks
(n=35)
wks
(n=19)
> 1.0 wk
(n=27)
In Utero Complications
21 (60.0)
13 (68.4)
20 (74.1)
Stillbirths
11 (31.4)
2 (10.5)
5 (18.5)
A retrospective case note analysis of 108 patients over a 10 year period from 1997 to The inclusion criteria used for severe preeclampsia were compatible with the RCOG guidelines. 6 patients were excluded because of inability to access proper records.
RESULTS
Demographics:
The mean age of the sample (N=101, since age was unknown for 1 patient) was ± 0.64 years (± SEM) with a range of 17 (min) to 43 (max) years
Figure 4
Past Medical History:
Most patients had no known prior medical history [74 (72.5%)]. Pre-Eclampsia [16 (15.7%)] was the most frequent complaint amongst those with previous conditions with Chronic Hypertension [4 (3.9%)] following second. See Table 1.
Neonatal ICU (NICU) Admission:
The POG at delivery demonstrated a negative correlation (r = ) with the number of days spent at NICU but this was not statistically significant (p=0.139). The average NICU stay (days) for those delivered at wks was ± 4.95 days with those delivered at wks staying an average ± 2.62 days. Conversely, the TTD demonstrated a weak positive correlation (r = 0.091) with the days spent at NICU (p=0.347). The average NICU stay for those with a TTD < 1 wk (n=25) was ± 3.28 days while for those with TTD ≥ 1wk (n=23), the average stay was ± 3.30 days.
POG at Delivery:
For purposes of analysis this was divided into 2 groups: 28-31wks (n=25) & 31-34wks (n=75). Time Till Delivery (TTD) is the difference (in days) between POG at delivery and on admission.
Table 2 shows that the wk group had a greater proportion of in utero fetal complications (68.0%) compared to those delivered at 28-31wks (p=0.207)
Neonatal Complications (NNC) including Neonatal Deaths (NND):
49 (87.5%) of the 56 patients admitted to NICU had neonatal complications inclusive of NEC, Sepsis, Pneumonia, Respiratory Distress, Icterus, Thrombocytopenia, DIC, IVH, HIE, Hypothermia, Hypoglycaemia and Seizures. 8 (16.3%) of those with complications died at NICU (i.e. Neonatal Deaths). The proportion of NNC was slightly greater at wks delivery [37(49.3%)] compared to wks [12(48.0%)]; p= However the proportion of NND was greater at the lower gestations [5(20.0%)] than wks [3 (4.0%)]; p= A slightly greater frequency of NNC at TTD ≥ 1wk [23 (50.0%)] as compared to TTD < 1wk [26 (48.1%)]; p= The incidence of NND decreased with increasing TTD, being 6.5% at TTD ≥ 1wk (n=46) as compared to 9.3% at TTD < 1wk (n=54); p=0.946.
CONCLUSION
A greater proportion of in utero & neonatal complications occurred as the Time Till Delivery was increased, although no statistical significance could be proved (small sample size)
TTD also showed a positive correlation with the no. of days spent at NICU post-delivery while POG at delivery showed a negative correlation with NICU stay. These findings also were not statistically significant
It is recommended that larger scale studies with multivariate analyses be conducted to weigh the effects of TTD (i.e. delaying delivery) on the fetus. Although prematurity is a major factor, delaying delivery may also contribute to a poorer fetal and neonatal outcome.