Preeclampsia and Prematurity: Implications for Maternal and Perinatal Outcomes in a Low-middle Income Country.

OBJECTIVES

To evaluate the maternal and perinatal outcomes of preeclampsia in accordance with the World Health Organization prematurity criteria, in a low-resource setting.

METHODS

This cross-sectional study was conducted from January 2017 to December 2019 at Aga Khan University Hospital, Karachi. All women with preterm preeclampsia were included in the study. Cases with fetal anomalies or incomplete medical records were excluded. Participants were grouped according to gestational age at delivery, following the World Health Organization prematurity classification: (I) extremely preterm birth (EPB): 24-27+6 weeks, (II) very preterm birth (VPB): 28-31+6 weeks, and (III) moderate to late preterm birth (MLPB): 32-36+6 weeks. Data was statistically analyzed.

RESULTS

The study included 324 women who delivered at the following gestation terms: EPB = 89 (27.5%), VPB = 35 (10.8%), and MLPB = 200 (61.7%), resulting in 331 neonates. Serious maternal complications developed in 45 (13.9%) women. Intrauterine death occurred in 18 (5.6%) cases. The median birth weights were significantly lower in the EPB and VPB groups. Of the 331 neonates, 21 (6.3%) died (20 in the EPB group and one in the MLPB group). Neonatal ICU admission, ventilator support, and low Apgar scores were also significantly more frequent in the EPB group.

CONCLUSIONS

Neonatal mortality rises significantly when delivery occurs before 28 weeks of gestation. Complications rise with preeclampsia before 32 weeks. Vigilant monitoring and timely referral improve outcomes, but in resource-limited settings like Pakistan, restricted access to specialized care indicate the need for targeted healthcare investment.