Improving Number of Antepartum Computerized Fetal Heart Monitoring Testing in Women with Preeclampsia with Severe Features does not Improve Maternal or Perinatal Outcome but Improve the Incidence of Caesarean Delivery

Objective: To evaluate if computerized cardiotocography (cCTG) twice a day improved maternal or perinatal outcome compared to daily cCTG in women with severe preeclampsia remote from term. Study design: This is a 5 year population-based observational study. Women with severe preeclampsia remote from term (<34 weeks) monitored with cCTG twice a day were compared to women with severe preeclampsia remote from term monitored with daily cCTG. Algorism for cCTG were based on Dawes/Redman antepartum CTG analysis by using Sonicaid (Sonicaid Obstetric Solutions, Huntleigh). The primary outcome of this study was the incidence of indicated preterm birth (PTB)<34 weeks. Results: 989 women with severe preeclampsia remote from term managed with expectant management (i.e., prolonging pregnancy beyond 48 h) were included in the analysis. 401 were monitored with daily cCTG and 588 were monitored with cCTG twice a day until delivery. After adjusting for confounders, we found that women with severe preeclampsia monitored with computerized CTG twice a day had a similar risk of indicated PTB<34 weeks, HELLP, DIC, pulmonary edema, abruption placentae, renal failure, eclampsia, cerebral hemorrhage, liver hemorrhage, maternal death, perinatal death and stillbirth compared to controls. Women monitored with cCTG twice a day had a significantly higher risk of cesarean delivery compared to those who were monitored with daily cCTG. Conclusion: Improving number of antepartum computerized fetal heart monitoring testing in women with preeclampsia with severe features remote from term does not improve maternal or perinatal outcome but improve the incidence of cesarean delivery. Therefore, we recommend daily antepartum cCTG in women with severe preeclampsia managed expectantly.