Clinical features and outcomes of pregnancies complicated by pre-ecplampsia necessitating in-utero transfer.
Pregnancy Hypertens 2018;
14:162-167. [PMID:
30527106 DOI:
10.1016/j.preghy.2018.09.009]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/30/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES
Pre-eclampsia (PE) is associated with significant risks of adverse perinatal outcomes, often necessitating transfer to a higher level of care for specialist perinatal management. In Victoria, Australia, the Paediatric Infant Perinatal Emergency Retrieval (PIPER) coordinates in-utero transfers of high-risk pregnancies. Our objectives were to report the clinical features and outcomes of women referred to PIPER with a primary diagnosis of PE, and subsequently transferred in-utero.
STUDY DESIGN
A retrospective audit of consecutive pregnancies referred to PIPER in 2013-2014 with a primary diagnosis of pre-eclampsia, ≥20 weeks' gestation and transferred in-utero.
MAIN OUTCOME MEASURES
Severity of disease, gestational age, transfer details and outcome until 7 days post transfer.
RESULTS
Over two years, 244 women were referred to PIPER with PE; 199 (82%) were subsequently transferred in-utero. Severe PE was diagnosed in 146 (73%) women. Overall, 64% presented 'early' (<32 weeks' gestation). Only 6% were ≥37 weeks. All but 2 women <32 weeks were transferred to a tertiary perinatal centre, compared with 39% of women ≥32 weeks. Within 7 days, 153/199 (77%) delivered, 10% remained in-patients and 12.5% were discharged. There were 165 livebirths and 3 stillbirths, with a mean gestational age of 30.7 weeks (SD 3.3 weeks). Twenty-nine women required high dependency or intensive care admission. No maternal deaths were reported.
CONCLUSION
Women referred to PIPER predominantly presented with early onset, severe PE and most delivered within 7 days of transfer. Data from this study provides important information for obstetric service planning in Victoria and comparable regions.
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