Severe preeclampsia at <25 weeks of gestation: maternal and neonatal outcomes

The purpose of this study was to determine maternal and neonatal outcomes of women who were delivered because of severe preeclampsia before 25 weeks of gestation.

We used a computerized database to identify 3800 women with preeclampsia among 35,937 deliveries from 1991 to 1997. Of these, 39 women (1%) with severe preeclampsia were delivered before 25 weeks of gestation. We abstracted outcomes in these women and their newborns.

All 39 women had severe preeclampsia as defined by clinical and/or laboratory criteria. Thirty-three of the 39 women had severe-range hypertension. Twenty-one women (54%) experienced morbidity that included abruptio placentae (n = 5), HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome (n = 9), renal insufficiency (n = 5), and eclampsia (n = 3). No women required dialysis or intensive care unit admission, and none of the women died. All maternal morbidities reversed after delivery. Twenty-two infants (55%) were live-born. Only 4 infants (10%) survived, all with severe handicaps.

In women with severe preeclampsia before 25 weeks of gestation, delivery is associated with minimal short-term maternal morbidities, although neonatal morbidity and death are appreciable.