Outcomes in Expectant Management for Patients with Preeclampsia with Severe Features

Purpose: This study aims to evaluate the outcomes of expectant management of preeclampsia with severe features compared to immediate delivery. Methods: Immediate delivery included anyone at or before steroid benefit (<48 hours) and those managed expectantly (> 48 hours). Retrospective chart review was conducted to identify patients diagnosed with preeclampsia with severe features at a large urban medical center from 2014 to 2020. Patients diagnosed after 34 weeks gestational age were excluded, as ACOG guidelines universally recommend delivery over expectant management for those individuals. Demographic data was collected including age, race, parity, marital status, and insurance type. Preeclampsia labs on admission were also collected. Hospital stays were reviewed to determine maximum blood pressures between admission and delivery, days between diagnosis and delivery, gestational age, and whether patients were delivered vaginally or by cesarean. Postpartum blood pressure values were collected at discharge, one week, six weeks, and one year postpartum. Documentation of antihypertensive prescriptions at discharge and follow-up visits was also reviewed. Chi-squared or Fisher’s exact test was used to compare categorical variables while t test was used for continuous variables. Data were log transformed to meet parametric assumptions and geometric mean (GM) was reported. A two-sided p-value<0.05 was used for the term of statistically significant. SAS 9.4 (SAS Institute Inc., Cary, NC) was used for all the data analysis. Results: A total of 149 patients met the inclusion criteria, with 48.3% (n=72) delivering within 48 hours, and the remaining 51.7% (n=77) delivering beyond 48 hours. Mean duration of expectant management was 9.96 days (range 3 - 77 days). There was a significant difference between groups with regard to parity, with nulliparous patients more likely to be in the expectant management group compared to multiparous patients (58.4% vs 41.7%, p=0.045). Additionally, patients delivered within 48 hours had a higher ALT (GM 25.81) and AST (GM 33.13) on admission when compared to others in expectant management group (with GM ALT 17.75 and AST 24.76). The differences were significant with p=0.019 and 0.025, respectively. There was no significant difference between groups with regard to race (p=0.63), maternal age (p=0.69), marital status (p=0.66), or insurance type (p=0.49). Gestational age at delivery and mode of delivery were also comparable between groups (p=0.14 and p=0.42, respectively). Postpartum blood pressure assessments at one week, six weeks, and one year showed no significant differences between groups. Similarly, readmission rates were not significantly different between the two groups (6.94% vs 5.19% for expectant management, p=0.74). Conclusion: Expectant management of preeclampsia with severe features lasted on average 8.95 days longer than immediate delivery. Despite this, there were not differences in mode of delivery, postpartum blood pressures, or adverse maternal outcomes. Notably, demographic factors such as race, age, marital status, and insurance type did not influence clinical outcomes, indicating that expectant management can be feasible across diverse patient populations. Given that delaying delivery did not result in worse long-term maternal outcomes, these findings support the potential for individualized management strategies in patients with severe preeclampsia. Further research is needed to refine expectant management protocols and assess neonatal outcomes to ensure optimal care for both mother and baby.