Terminating pregnancy for severe hypertension when the fetus is considered non-viable: a retrospective cohort study.
OBJECTIVE
To investigate frequency and practise of termination of pregnancy for early-onset hypertensive disorders where the fetus is considered to be non-viable.


METHODS
Retrospective cohort study in all Dutch tertiary perinatal care centres (n=10), between January 2000 and January 2014. All women who underwent termination of pregnancy, without fetal surveillance or intention to intervene for fetal reasons, for early-onset hypertensive disorders in pregnancy, were analyzed. Women eligible for this study were identified in the local delivery databases. Medical records were used to collect relevant data.


RESULTS
Between January 2000 and January 2014, 2,456,584 women delivered in The Netherlands, of which 238,448 (9.7%) in a tertiary care centre. A total of 161 pregnancy terminations (11-12 per year) for severe early-onset preeclampsia were identified, including 6 women with a twin pregnancy. Mean gestational age at termination was 172 days (GA 244/7)±9.4 days. In 70% of cases termination was performed at or shortly after 24 weeks' gestation. 74.5% of women developed HELLP syndrome (n=96), eclampsia (n=10) or needed admission to an ICU (n=14). Birth weight was below 500g in 64% of cases. In 69% of the cases the estimated fetal weight was within a 10% margin of the actual birth weight.


CONCLUSIONS
Termination of pregnancy for early-onset hypertensive disorders without intervention for fetal indication occurs approximately 12 times per year in The Netherlands. More data are needed to investigate contemporary best practice regarding termination of pregnancy for early-onset hypertensive indications at the limits of fetal viability. Considering the frequency of maternal complications, termination of pregnancy and not expectant management should be considered for all women presenting with severe early onset hypertensive disorders at the limits of fetal viability.
VU Medical Center Amsterdam, The Netherlands. Electronic address: eerdenl@maasstadziekenhuis.nl.
Leonoor
L
Van Eerden
Beatrix Hospital Gorinchem, The Netherlands.
Miriam F
MF
Van Oostwaard
University Medical Center Groningen, The Netherlands.
Gerda G
GG
Zeeman
University Medical Center Utrecht, The Netherlands.
Godelieve C M
GC
Page-Christiaens
Academic Medical Center Amsterdam, The Netherlands.
Eva
E
Pajkrt
Erasmus Medical Center Rotterdam, The Netherlands.
Johannes J
JJ
Duvekot
Radboud University Medical Centre Nijmegen, The Netherlands.
Frank P
FP
Vandenbussche
Maxima Medical Center Veldhoven, The Netherlands.
Swan G
SG
Oei
Maastricht Medical Center, The Netherlands.
Hubertina C J
HC
Scheepers
Isala Clinics Zwolle, The Netherlands.
Jim
J
Van Eyck
Leiden University Medical Center, The Netherlands.
Johanna M
JM
Middeldorp
University Medical Center Utrecht, The Netherlands.
Steven V
SV
Koenen
VU Medical Center Amsterdam, The Netherlands.
Christianne J M
CJ
De Groot
Radboud University Medical Centre Nijmegen, The Netherlands.
Antoinette C
AC
Bolte
D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D004461:Eclampsia / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005865:Gestational Age; D017359:HELLP Syndrome / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D009426:Netherlands; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000628:therapy*; D011247:Pregnancy; D012189:Retrospective Studies
Early-onset preeclampsia; Non-viable fetus; Termination of pregnancy