Title:	Maternal complications of severe preeclampsia in a level III University Hospital
Author(s):	García García C.R., Guasch Arévalo E., Sancho de Ávila A., Schiraldi R., Gilsanz Rodríquez F.
Institute(s):	La Paz University Hospital, Dept of Anaesthesiology & Intensive Care, Madrid, Spain
Text:	Background and Goal of Study: In the recent years, the incidence of some conditions considered risk factors for preeclampsia have increased: obesity, hypertension, assisted reproductive technology (ART) and multiple gestation. This may have influenced prognosis of severe preeclampsia (SP). The goal of study was to analyze maternal complications of SP in a level III University Hospital.
Materials and methods: With approval from the Local Ethics Committee, a prospective observational study of women with SP admitted to a high dependency unit in a level III University Hospital, from 2010 to 2012, was performed. SP was established according to international criteria1. The following complications were studied: obstetric hemorrhage (>500 ml after vaginal delivery or > 1000 ml after caesarean section), renal dysfunction (serum creatinine >1.2 mg/dl), hepatopathy (AST/ALT ≥70 IU/L), HELLP syndrome, "placental abruption", pulmonary oedema, perinatal death (≥20 weeks of gestation to the first 7 days of life) and eclampsia.
Results and discussion: 276 cases were analyzed. 17.3% (n=47) of patients were obese, 16.7% (n=46) had a multiple pregnancy, 16.3% (n=45) had been undergoing ART and 8.7% (n=24) had chronic hypertension.
42.7% (n=118) of patients developed at least one complication. The incidence of maternal complications was: obstetric hemorrhage 17.4% (n=48), renal dysfunction 11.2% (n=31), hepatopathy 8.3% (n=23), HELLP syndrome 6.5% (n=18), "placental abruption” 5.8% (n=16), pulmonary oedema 5.1% (n=14), perinatal death 3.6% (n=10) and eclampsia 1.8% (n=5). Perinatal death was more frequent in women with chronic hypertension (12.5%, n=3 vs 2.8%, n=7 normotensive, p=0.046), early-onset disease (< 34 weeks) (10.8%, n=9 vs 0.5%, n=1 late, p< 0.001) or pathological uterine artery Doppler (10.5%, n=6 vs0%, n=0 normal, p< 0.001).
Obstetric hemorrhage and pulmonary oedema were more frequent than those reported in the literature, perhaps due to the prospective design and the high percentage of multiple pregnancies and early-onset forms (30.1%, n=83). Perinatal mortality rate was slightly lower, probably because of the realization of the study in a national reference neonatal intensive care centre.
Conclusion(s): The most frequent complications were obstetric hemorrhage and renal dysfunction. Early-onset preeclampsia was associated with higher perinatal death rate.
References: 1Steegers EA, von Dadelszen P, Duvekot JJ, et al. Lancet. 2010; 376: 631-44.