252. Why do we have too many caesarean sections in Brazil, even in patients with pre-eclampsia?

Introduction Hypertension in pregnancy, especially preeclampsia (PE), may result in maternal and perinatal complications and the best form of treatment is the interruption of gestation through the safest method for the mother and baby. In Brazil, there are high rates of Cesarean (CS) among patients with PE. Would it be possible to change these routines to reduce risks and costs associated with the actual patterns of care? Objective To assess the type of delivery in patients with PE in a public maternity in Sao Paulo (Brazil) and propose changes in this pattern. Methodology Retrospective Cohort of 117 patients with PE treated in a reference center (MEVNC) in 2016 and 2017. Maternal variables were assessed and related to childbirth and perinatal period. Baseline characteristics and labor and delivery characteristics according to PE early and late were analyzed. Results The average maternal age was 29.0 years, 51.3 being nulliparous and the BMI average was 29.1. Mild PE was present in 85.0%. The overall cesarean rate was 32.0%. Among patients with early PE the rate was 72.0% while in patients with late PE the rate was 77.0%. The reasons for CS were maternal risk in 30.7% and fetal risk in 22.7%. Discussion The overall rate of CS of the institution being on average, 34%. However in patients with PE CS rates are very high. Our results contrast with the literature, when compared with different places. Two aspects could be considered: insecurity related to maternal prognosis and the difficulties of assessing fetal well-being. Two interventions could be tested to modify this pattern: the adoption of the model PIERS for maternal care and fetal monitoring for fetal scalp samples for pH and lactate evaluation. In this way, the introduction of these alternatives could innovate the current standard of clinical practice.