title: Expectant management of severe preeclampsia at less than 27 weeks' gestation: maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management.
abstract: OBJECTIVE
  The objective of the study was to determine perinatal outcome and maternal morbidities based on gestational age (GA) at the onset of expectant management in severe preeclampsia at less than 27 weeks.
  
  
  METHODS
  This was a retrospective analysis of outcome in patients with severe preeclampsia. Forty-six patients (51 fetuses) with severe preeclampsia at less than 27 weeks were studied. Corticosteroids were administered beyond 23 weeks. Perinatal and maternal complications (a composite maternal morbidities including HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, pulmonary edema, eclampsia, and renal insufficiency were analyzed.
  
  
  RESULTS
  Four patients had multifetal gestations (1 triplet, 3 twins). Median days of prolongation was 6 (range 2-46). Overall perinatal survival was 29 of 51 (57%). Birthweights of 27 (53%) were less than 10%, and 18 (35%) were less than 5%. There were no perinatal survivors in those with a GA less than 23 weeks, at 23 to 23 6/7 weeks, 2 of 10 (20%) survived, and both reached 26 weeks at delivery. For those at 24 to 24 6/7, 25 to 25 6/7, and 26 to 26 6/7 weeks, the perinatal survival rates were 5 of 7 (71%), 13 of 17 (76%), and 9 of 10 (90%), respectively; but rates of respiratory complications were high. There were no maternal deaths, but overall maternal morbidity was 21 of 46 (46%), but was 9 of 14 (64%) in those at less than 24 weeks.
  
  
  CONCLUSIONS
  Perinatal outcome in severe preeclampsia in the midtrimester is dependent on GA at onset of expectant management and GA at delivery. Given the high maternal morbidity and extremely low perinatal survival in expectant management at less than 24 weeks, termination of pregnancies should be offered after extensive counseling.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine Division of Maternal-Fetal Medicine, Cincinnati, OH 45221, USA.
authors.forename: Annette E
authors.initials: AE
authors.lastname: Bombrys
authors.forename: John R
authors.initials: JR
authors.lastname: Barton
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Nowacki
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.forename: Leeya
authors.initials: L
authors.lastname: Pinder
authors.forename: Helen
authors.initials: H
authors.lastname: How
authors.forename: Baha M
authors.initials: BM
authors.lastname: Sibai
mesh_terms: D000037:Abruptio Placentae / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D005260:Female; D005865:Gestational Age; D006801:Humans; D009017:Morbidity; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018566:Pregnancy, High-Risk; D011272:Pregnancy, Multiple; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment