Preeclampsia with Severe Features-Assessing the Impact of Headache and Visual Disturbances [25O]. (May 2018)

• Record Type: Journal Article
• Authors: Kia, Farnaaz; Rincon, Monica; Beeraka, Sridivya Spurthi; Burwick, Richard M.
• Is Part Of: Obstetrics and gynecology. Volume 131(2018)Supplement 1
• Publication Date: 2018-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000533160.85503.61
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: In pregnant women with hypertension, the presence of headache or visual symptoms may prompt early delivery due to concern for preeclampsia (PE) and eclampsia. We evaluated subjects with preeclampsia with severe features (PE-SF) to assess the impact of these symptoms on maternal and neonatal outcomes. METHODS: Retrospective cohort study of subjects with PE-SF, ≥23 weeks gestation at a single institution (October 2013-May 2017). Subjects were identified by ICD-9 and ICD-10 codes, with charts reviewed for diagnostic accuracy. Symptoms like headache and visual disturbances were determined by physician documentation. We compared outcomes in three groups: 1. No headache or visual disturbances; 2. Severe headache only; 3. Severe headache and visual disturbances. Significance determined by chi-square or t-test. RESULTS: Among 8, 645 deliveries, 318 women (3.7%) delivered with PE-SF; 192 (60.4%) had no headache or visual disturbances, 68 (21.4%) severe headache only, and 39 (12.3%) both headache and visual disturbances. Maternal admission to the intensive care unit, pulmonary edema, kidney injury, or hemolysis, elevated liver enzymes, low platelet count syndrome, were no different between groups. However, those with both headache and visual disturbances had increased risk of eclampsia, p=0.016. Those with headache were delivered earlier (p<0.0001), more likely to have neonates born preterm (p=0.007) or admitted to the Neonatal Intensive Care Unit (NICU), p=0.02. CONCLUSION: We find that headache and visual disturbances contribute disproportionately to preterm delivery and NICU admission rates in PE-SF. However, the increased risk of eclampsia in this setting suggests that such action is justifiable.