title: Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation, a case series.
abstract: OBJECTIVE
  To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation.
  
  
  METHODS
  Nationwide case series.
  
  
  METHODS
  All Dutch tertiary perinatal care centres.
  
  
  METHODS
  All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014.
  
  
  METHODS
  Women were identified through computerised hospital databases. Data were collected from medical records.
  
  
  METHODS
  Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival).
  
  
  RESULTS
  We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days.
  
  
  CONCLUSIONS
  Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling.
  
  
  CONCLUSIONS
  Severe early onset pre-eclampsia comes with high maternal complication rates and poor neonatal survival.
authors.affiliation: Department of Obstetrics and Gynaecology, IJsselland Ziekenhuis, Capelle aan den Ijssel, the Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: van Oostwaard
authors.affiliation: Department of Obstetrics and Gynaecology, Maasstad Ziekenhuis, Rotterdam, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van Eerden
authors.affiliation: Department of Obstetrics and Gynaecology, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: de Laat
authors.affiliation: Department of Obstetrics and Gynaecology, Erasmus Medisch Centrum, Rotterdam, the Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.affiliation: Department of Obstetrics and Gynaecology, Universitair Medisch Centrum Groningen, Groningen, the Netherlands.
authors.forename: Jjhm
authors.initials: J
authors.lastname: Erwich
authors.affiliation: Department of Obstetrics and Gynaecology, Leids Universitair Medisch Centrum, Leiden, the Netherlands.
authors.forename: Kwm
authors.initials: K
authors.lastname: Bloemenkamp
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud Universitair Medisch Centrum, Nijmegen, the Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Bolte
authors.affiliation: Department of Obstetrics and Gynaecology, Isala Ziekenhuis, Zwolle, the Netherlands.
authors.forename: Jpf
authors.initials: J
authors.lastname: Bosma
authors.affiliation: Department of Obstetrics and Gynaecology, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands.
authors.forename: S V
authors.initials: SV
authors.lastname: Koenen
authors.affiliation: Department of Paediatrics, Erasmus Medisch Centrum, Rotterdam, the Netherlands.
authors.forename: R F
authors.initials: RF
authors.lastname: Kornelisse
authors.affiliation: Department of Obstetrics and Gynaecology, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Rethans
authors.affiliation: Department of Obstetrics and Gynaecology, Maxima Medisch Centrum, Veldhoven, the Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: van Runnard Heimel
authors.affiliation: Department of Obstetrics and Gynaecology, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands.
authors.forename: Hcj
authors.initials: H
authors.lastname: Scheepers
authors.affiliation: Department of Obstetrics and Gynaecology, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Ganzevoort
authors.affiliation: School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Bwj
authors.initials: B
authors.lastname: Mol
authors.affiliation: Department of Obstetrics and Gynaecology, VU Universitair Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: de Groot
authors.affiliation: Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.
authors.forename: Ipm
authors.initials: I
authors.lastname: Gaugler-Senden
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000175:diagnosis* / Q000401:mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Maternal and neonatal outcome; preterm birth; prolongation; severe pre-eclampsia