Predictors of neonatal outcome in women with severe preeclampsia or eclampsia between 24 and 33 weeks' gestation

OBJECTIVE: We sought to characterize predictors of neonatal outcome in women with severe preeclampsia or eclampsia who were delivered of their infants preterm. STUDY DESIGN: We performed a retrospective analysis of 195 pregnancies delivered between 24 and 33 weeks' gestation because of severe preeclampsia or eclampsia. Multiple logistic regression and univariate χ² analysis were performed for the dependent outcome variables of survival and respiratory distress syndrome by use of independent fetal and maternal variables. A P value of < .05 was considered significant. RESULTS: In the multivariate analysis, respiratory distress syndrome was inversely related to gestational age at delivery (P = .0018) and directly related to cesarean delivery (P = .02), whereas survival was directly related to birth weight (P = .00025). There was no correlation in the multivariate analysis between respiratory distress syndrome or survival and corticosteroid use, composite neonatal morbidity, mean arterial pressure, eclampsia, or abruptio placentae. In the univariate analysis respiratory distress syndrome was associated with cesarean delivery (odds ratio, 7.19; 95% confidence interval, 2.91-18.32). The incidence of intrauterine growth restriction increased as gestational age advanced. Furthermore, intrauterine growth restriction decreased survival in both the multivariate (P= .038; odds ratio, 13.2; 95% confidence interval, 1.16-151.8) and univariate (P= .001; odds ratio, 5.88; 95% confidence interval, 1.81-19.26) analyses. CONCLUSION: The presence of intrauterine growth restriction adversely affected survival independently of other variables. Presumed intrauterine stress, as reflected by the severity of maternal disease, did not improve neonatal outcome.