Expectant Management of Severe Preeclampsia at 27 0/7 to 33 6/7 Weeks' Gestation: Maternal and Perinatal Outcomes According to Gestational Age by Weeks at Onset of Expectant Management

We sought to determine perinatal outcome and maternal morbidities based on gestational age (GA) at onset of expectant management in severe preeclampsia (PE) between 27 0/7 and 33 6/7 weeks. In this retrospective analysis of outcome in patients with severe preeclampsia, we studied 66 patients (71 fetuses) with severe PE at 27 0/7 to 33 6/7. All patients received corticosterolds. Perinatal and maternal complications were analyzed. Five patients had twin gestations. Median for days of prolongation was 5 days (range, 3 to 35). Birth weights of 19 (27%) were < 10% for gestational age, and 6 (8%) were < 5%. All fetuses survived except for one neonatal death at 27 weeks, and three infants had chronic lung disease-two at 27 and one at 28 weeks-but there were no cases of intraventricular hemorrhage (>= grade). Rate of abruption was significantly higher at 27 to 28 weeks as compared with > 28 weeks (25% vs 6%, p = 0.05). There was no eclampsia, and two had transient renal insufficiency at 27 weeks. Four of 11 (36%) patients with expectant management at >= 32 weeks had pulmonary edema or hemolytic anemia, elevated liver enzymes, and low platelet count. During expectant management, rate of respiratory distress syndrome and other serious neonatal complications decrease with increasing GA, supporting a role for such management in early severe preeclampsia. Because there is significant maternal morbidity at >= 32 weeks with minimal neonatal benefit, consideration should be given for delivery of these pregnancies following corticosteroid administration.