Am J Perinatol
DOI: 10.1055/a-2097-1212
Short Communication

Risk Factors and Risk for Severe Maternal Morbidity in Severe Preeclampsia Complicated by Pulmonary Edema: A Case–Control Study

1   Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Adina R. Kern-Goldberger
2   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Sindhu K. Srinivas
2   Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
› Author Affiliations
Funding Adina Kern-Goldberger is supported by a National Institutes of Health T32 Training Grant in Perinatal Epidemiology at the University of Pennsylvania (grant number: T32-HD007440)


Objective The objective of this study is to examine risk factors and adverse outcomes related to preeclampsia with severe features complicated by pulmonary edema.

Study Design This is a nested case–control study of all patients with preeclampsia with severe features who delivered in a tertiary, urban, academic medical center over a 1-year period. The primary exposure was pulmonary edema and the primary outcome was a composite of severe maternal morbidity (SMM), defined according to the Centers for Disease Control and Prevention and based on International Classification of Diseases, 10th revision, Clinical Modification codes. Secondary outcomes included postpartum length of stay, maternal intensive care unit admission, 30-day readmission, and discharge on antihypertensive medication. A multivariable logistic regression model adjusting for clinical characteristics related to the primary outcome was used to determine adjusted odds ratios (aOR) as measures of effect.

Results Of 340 patients with severe preeclampsia, there were seven cases of pulmonary edema (2.1%). Pulmonary edema was associated with lower parity, autoimmune disease, earlier gestational age at diagnosis of preeclampsia and at delivery, and cesarean section. Patients with pulmonary edema demonstrated increased odds of SMM (aOR: 10.11, 95% confidence interval [CI]: 2.13–47.90), extended postpartum length of stay (aOR: 32.56, 95% CI: 3.95–268.45), and intensive care unit admission (aOR: 102.85, 95% CI: 7.43–1422.92) compared with those without pulmonary edema.

Conclusion Pulmonary edema is associated with adverse maternal outcomes among patients with severe preeclampsia, and is more likely to affect patients who are nulliparous, have an autoimmune disease, and are diagnosed preterm.

Key Points

  • Pulmonary edema increases odds of severe maternal morbidity in preeclamptics.

  • Pulmonary edema prolongs postpartum and intensive care unit stay in preeclamptics.

  • Risk factors for pulmonary edema include nulliparity and autoimmune disease.

  • Earlier diagnosis of severe preeclampsia increases risk of pulmonary edema.

Publication History

Received: 22 August 2022

Accepted: 19 May 2023

Accepted Manuscript online:
22 May 2023

Article published online:
19 June 2023

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