PP171. Hospitalized preterm mild preeclamptics: Is there a difference in outcomes between isolated or superimposed...

Currently the standard of care is to admit and monitor patients with preterm mild preeclampsia. This is particularly important if the disease is superimposed in patients with chpt or with isolated disease if proteinuria is over 500mg in 24hours. Despite the common nature of this disease process little is known about the outcomes of these two groups.

The objective of this project is to compare the maternal and neonatal outcomes of patients hospitalized with isolated mild preterm preeclampsia to those with preterm superimposed preeclampsia.

All patients admitted between 1/2008 and 12/2011 that were expectantly managed with either mild isolated preterm preeclampsia or chpt with mild superimposed preeclampsia at our tertiary center were evaluated for inclusion in this retrospective cohort study. This study was IRB approved. To be included in the study a patient must have singleton gestation, no overt diabetes, no major chronic medical conditions, no major obstetrical complications, no congenital anomaly, or planned delivery before 37weeks. Patients with the following maternal complications were excluded: lupus, renal disease, and cardiac disease. Patients with the following obstetrical complications were excluded: multiple gestations, preterm labor, placenta previa, and preterm PROM. Mild preeclampsia and chpt were diagnosed using ACOG criteria. Patients were not included if they had severe disease being treated expectantly. Patients that met inclusion criteria were divided into two groups based on the presence of chpt. All patients were admitted to labor and delivery, treated with corticosteroids if indicated and were managed as inpatients until delivery. All patients had an ultrasound on admission, frequent laboratory evaluations, and daily antepartum testing. Outcomes of interest included latency period in days, incidence of IUGR, incidence of abruption, indication for delivery, maternal complications as well as neonatal morbidity and mortality.

To date, we have identified 115 patients that met inclusion criteria and were included in this ongoing study. Fifty nine had isolated mild preeclampsia and 56 patients had chronic hypertension with superimposed preeclampsia. The following table compares the results of the two groups. Differences between the groups included age (24 vs. 30yrs, p<0.01), race with more whites having preeclampsia and more blacks having superimposed disease, days in hospital were longer in the superimposed group (9 vs. 13days, p<0.01) despite there being no significant difference in the latency period (6 vs. 9days, p=0.35). More superimposed patients developed pulmonary edema, (0% vs. 7%, p=0.05). A trend for increased abruptions was seen in the isolated group (9% vs. 0%, p=0.06). Vaginal delivery was more common in the preeclamptic group and repeat section more common in the superimposed group. No differences in neonatal outcomes were seen.

Patients with preeclampsia were more likely younger, white and delivered vaginally when compared to patients with superimposed disease. While the superimposed patients were more likely older, black, had more pulmonary edema, were more likely treated with antihypertensives both antenatally and postpartum and were delivered by repeat section than patients with isolated disease. Neonatal outcomes were similar between the groups.