(767) Normotension is not predictive of duration of expectant management of preterm preeclampsia with severe features

To identify the optimal blood pressure range during expectant management of preterm preeclampsia with severe features. 

Study Design:

Multicenter retrospective cohort study of pregnant people with preterm ( < 34 weeks gestation) preeclampsia with severe features by severe hypertension criteria who underwent a period of expectant management >48 hours from 2017-2022. People were excluded if they had chronic hypertension, fetal anomaly, or underwent pregnancy termination. Primary outcomes were completed percentage of maximum potential duration of expectant management until goal of 34 weeks and attainment of 34 weeks gestation. ANOVA, Kruskal-Wallis test, t-test, Wilcoxon rank-sum test, and multivariate regression were performed with p< 0.05 considered statistically significant.  

Results:

186 people met inclusion criteria. Antepartum blood pressures were normal ( < 140/90) 0-33% of measurements in 36 people (19.4%), 34-66% in 94 people (50.5%), and 67-100% in 56 people (30.1%). Percentage of normal blood pressures was not associated with completed percentage of maximum potential duration of expectant management (Figure 1), but increasing percentage of blood pressures in the severe range was associated with lower completed percentage of maximum potential duration of expectant management (Figure 2). Multivariate analysis demonstrated that percentage of blood pressures in the severe range (OR 0.91, CI 0.86-0.96) and diagnosis of fetal growth restriction (OR 0.41, CI 0.23-0.74) were associated with a lower completed percentage of maximum potential duration of expectant management while maintenance antihypertensive medication (OR 2.45, CI 1.06-5.67) was associated with a higher completed percentage. Neither the percentage of normal blood pressures (p=0.7) nor the percentage of blood pressures in the severe range (p=0.9) were associated with attaining 34 weeks gestation. 

Conclusion:

Percentage of normal as opposed to elevated blood pressures was not predictive of the duration of expectant management of preterm preeclampsia with severe features.