Prediction of adverse maternal outcomes in preeclampsia at term

Preeclampsia complicates 5-8% of all pregnancies and is associated with high rates of maternal and perinatal morbidity. The majority of cases occur at term gestations where the baby can be safely delivered. The preeclampsia disease process however can progress in the mother resulting in significant morbidity. In this study we were interested in examining the number of patients developing preeclampsia with severe features at term. We also investigated whether factors at admission might be predictive of disease progression. We performed a retrospective cohort study at a tertiary obstetric hospital in Melbourne, Australia from 2015 to 2017. There were 124 participants presenting with preeclampsia at term and included in our study. After admission, 44.4% progressed to preeclampsia with severe features. Disease features at admission associated with disease progression were chronic hypertension, elevated systolic blood pressure, reduced haemoglobin and elevated creatinine. Using predictive modelling, we determined that a combination of these features showed good discrimination (area under ROC = 0.88 (95% confidence interval 0.82-0.94)) with good performance (negative predictive value 80% and positive predictive value 87%) for predicting progression to preeclampsia with severe features. Almost half of the women presenting with preeclampsia at term will progress to preeclampsia with severe features. Admission characteristics can be used to predict those at risk of disease progression.