Direct versus referred admission to the maternity hospital due to preeclampsia: Does it influence pregnancy outcomes?

OBJECTIVES

This study describes maternal and perinatal outcomes of women with preeclampsia (PE) according to hospital admission characteristics: referral from lower complexity settings or directly admitted at the reference hospital.

METHODS

This is a cross-sectional study considering women with PE who were admitted for childbirth between September 2019 and August 2021, at a Brazilian university hospital. Women were divided into hospitalized at the tertiary center or referred women (from facilities in the region). The main outcome measures were need for magnesium sulfate (proxy for severity), mean gestational age (GA) at childbirth, 5-min Apgar score <7, birthweight, and maternal and perinatal deaths.

RESULTS

There were 3914 childbirths, with 428 with PE (10.9%). Among PE cases, 37 (8.6%) were referred cases. Magnesium sulfate was used in 89.2% of the referred women and 44.8% of non-referred (P < 0.001). The mean GA at childbirth differed significantly between groups (referred cases: 33.6 ± 3.27 weeks vs. 36.1 ± 2.97 weeks, P < 0.001). Five-minute Apgar <7 was more frequent among referred cases (13.9% vs. 4.1%, P = 0.03). There were no maternal deaths and no differences in perinatal deaths between groups. Newborns from referred mothers had lower mean birthweight (2150 ± 946 vs. 2730 ± 800 g, P < 0.001) and needed more intensive care (72.2 vs. 34.9%, P < 0.001).

CONCLUSION

Referred women with PE had worse maternal and perinatal outcomes than those who were directly hospitalized in the tertiary center, which highlights the importance of timely diagnosis and delays associated to referral of women with PE.