Maternal and Neonatal Outcomes of Severe Preeclampsia: Delivery at 34–36 Weeks versus Term: A Retrospective Study at a Tertiary Referral Hospital

Abstract

Introduction: Severe preeclampsia (SPE) is a leading cause of maternal and perinatal morbidity and mortality in developing countries. The optimal timing of delivery remains debated, particularly whether termination at 34 – 36 weeks worsens outcomes compared with term delivery. This study compared maternal and neonatal outcomes of SPE delivered at 34 – 36 weeks versus at term.
Methods: This retrospective observational study used medical records of women with SPE who delivered at Dr. Hasan Sadikin General Hospital, Bandung, during 2020 – 2023. Total sampling yielded 336 women (120 at 34 – 36 weeks; 216 at term). Outcomes were analysed using Chi-square, Fisher exact, and Mann-Whitney tests, with p≤0.05 considered significant.
Results: Maternal mortality did not differ between the 34 – 36-week and term groups (5.0% vs 3.7%; p=0.569), nor did delivery mode, postpartum haemorrhage, or premature rupture of membranes. Among singletons, neonatal outcomes differed significantly for birth weight, one-minute APGAR, and five-minute APGAR (all p<0.05); ten-minute APGAR, NICU admission, respiratory distress, and neonatal mortality (6.5% vs 2.9%; p=0.200) did not differ. No outcome differed among twins.
Conclusion: Delivery at 34 – 36 weeks for severe preeclampsia did not show a significant difference in maternal and neonatal mortality compared with term delivery, though neonates born earlier had lower birth weight and poorer early APGAR adaptation. Indicated delivery within this window may be considered according to maternal-fetal condition and neonatal readiness, with cautious interpretation given the retrospective design.

Luaran Maternal dan Neonatal Preeklamsia Berat: Persalinan Usia 34 – 36 Minggu versus Aterm: Studi Retrospektif di Rumah Sakit Rujukan Tersier

Abstrak
Latar Belakang: Preeklamsia berat (PEB) merupakan penyebab utama morbiditas dan mortalitas maternal serta perinatal di negara berkembang. Waktu terminasi optimal masih diperdebatkan, terutama apakah persalinan pada usia 34 – 36 minggu memperburuk luaran maternal dan neonatal dibandingkan aterm. Penelitian ini membandingkan luaran maternal dan neonatal PEB yang dilahirkan pada usia 34 – 36 minggu dan aterm.
Metode: Penelitian observasional retrospektif menggunakan rekam medis perempuan dengan PEB yang bersalin di RSUP Dr. Hasan Sadikin Bandung periode 2020 – 2023. Total sampling memperoleh 336 subjek (120 bersalin pada usia 34 – 36 minggu; 216 aterm). Data dianalisis dengan uji Chi-square, Exact Fisher, dan Mann-Whitney; p≤0,05 dianggap bermakna.
Hasil: Mortalitas maternal tidak berbeda antara kelompok 34 – 36 minggu dan aterm (5,0% vs 3,7%; p=0,569), demikian pula jenis persalinan, perdarahan pascapersalinan, dan ketuban pecah dini. Pada kehamilan tunggal, luaran neonatal berbeda bermakna pada berat lahir, APGAR menit pertama, dan APGAR menit kelima (semua p<0,05); APGAR menit kesepuluh, perawatan NICU, gangguan napas, dan mortalitas neonatal (6,5% vs 2,9%; p=0,200) tidak berbeda. Tidak ditemukan perbedaan luaran pada kehamilan gemelli.
Kesimpulan: Persalinan pada usia 34 – 36 minggu untuk preeklamsia berat tidak menunjukkan perbedaan bermakna dalam mortalitas maternal dan neonatal dibandingkan persalinan aterm, meskipun neonatus yang dilahirkan lebih awal menunjukkan berat lahir lebih rendah dan APGAR awal yang lebih buruk. Persalinan terindikasi pada usia ini dapat dipertimbangkan sesuai kondisi maternal-fetal dan kesiapan neonatal, dengan interpretasi hati-hati mengingat desain retrospektif.