Outcome and risk factors of early onset severe preeclampsia

( views:28, downloads:0 )
Author:
GONG Yun-hui(Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China)
JIA Jin(West China School of Medicine, Sichuan University, Chengdu,Sichuan 610041, China)
L(U) Dong-hao(Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China)
DAI Li(West China School of Medicine, Sichuan University, Chengdu,Sichuan 610041, China)
BAI Yi(West China School of Medicine, Sichuan University, Chengdu,Sichuan 610041, China)
ZHOU Rong(Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China)
Journal Title:
Chinese Medical Journal
Issue:
Volume 125, Issue 14, 2012
DOI:
10.3760/cma.j.issn.0366-6999.2012.14.039
Key Word:
early-onset severe preeclampsia;cardiovascular complications;perinatal outcome;risk factors

Abstract: Background Early onset severe preeclampsia is a specific type of severe preeclampsia,which causes high morbidity and mortality of both mothers and fetus.This study aimed to investigate the clinical definition,features,treatment,outcome and risk factors of early onset severe preaclampsia in Chinese women.üMethods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows:group A (less than 32 weeks,73 cases),group B (between 32 and 34 weeks,71 cases),and group C (greater than 34 weeks,269 cases).The demographic characteristics of the subjects,complications,delivery modes and outcome of pregnancy were analyzed retrospectively.üResults The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B,prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B.Liver and kidney dysfunction,pleural and peritoneal effusion,placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups.Twenty-four-hour urine protein levels at admission,intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia.Gestational week at admission and delivery week were also risk factors that affected perinatal outcome.Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks,and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks.Independent risk factors should be used to tailor the optimized individual treatment plan,to balance both maternal and neonatal safety.

  • 1.Hauth JC,Ewell MG,Levine RL,Esterlitz JR,Sibai BM,Curet LB.Pregnancy outcomes in healthy nulliparas who developed hypertension.Calcium for Preeclampsia Prevention Study Group.Obstet Gynecol 2000; 95:24-28.
  • 2.Cunningham FG,Veno KJ,Bloom SL.Pregnancy hypertension.In:Williams Obstetrics.23 ed.2010; 706-755.
  • 3.American Academy of Pediatrics,Committee on Fetus and Newborn,American College of Obstetricians and Gynecologists and Committee on Obstetric Practice.The Apgar score.Pediatrics 2006; 117:1444-1447.
  • 4.Blackwell SC,Redman ME,Tomlinson M,Berry SM,Sorokin Y,Cotton DB.Severe pre-eclampsia remote from term:what to expect of expectant management.J Matem Fetal Neonatal Med 2002; 11:321-324.
  • 5.von Dadelsezen P,Magee LA,Roberts JM.Subclassification of preeclampsia.Hypertens Pregnancy 2003; 22:143-148.
  • 6.Haddad B,Sibai BM.Expectant management of severe preeclampsia:proper candidates and pregnancy outcome.Clin Obstet Gynecol 2005; 48:430-440.
  • 7.Sibai BM,Barton JR.Expectant management of severe preeclampsia remote from term:patient selection,treatment,and delivery indiciations.Am J Obstet Gynecol 2007; 196:514.
  • 8.Bombrys AE,Barton JR,Habli M,Sibai BM.Expectant management of severe preeclampsia at 27(0/7) to 33(6/7)weeks' gestation:maternal and perinatal outcomes according to gestational age by weeks at onset of expectant management.Am J Preinatol 2009; 26:441-446.
  • 9.Sirohiwal D,Dahiya K,Khaneja N.Use of 24-hour urinary protein and calcium for prediction of preeclampsia.Taiwan J Obstet Gyneco12009; 48:113-115.
  • 10.Newman MG,Robiehaux AG,Stedman CM,Jaekle RK,Fontenot MT,Dotson T,et al.Perinatal outcomes in preeclampsia that is complicated by massive proteinuria.Am J Obstet Gynecol 2003; 188:264-268.
  • 11.Hall DR,Odendaal HJ,Steyn DW.Delivery of patients with early onset,severe pre-eclampsia.Int J Gynaecol Obstet 2001; 74:143-150.
  • 12.Alanis MC,Robinson CJ,Hulsey TC,Ebeling M,Johnson DD.Early-onset severe preeclampsia:induction of labor vs.elective cesarean delivery and neonatal outcomes.Am J Obstet Gynecol 2008; 199:262.
  • 13.Coppaqe KH,Polzin WJ.Severe preeclampsia and delivery outcomes:Is immediate cesarean delivery beneficial? Am J Obstet Gynecol 2002; 186:921-923.
  • 14.Wax JR,Cartin A,Pinette MG,Blackstone J.Patient choice cesarean:an evidence-based review.Obstet Gynecol Surv 2004; 59:601-616.
  • 15.Mashiloane CD,Moodley J.Induction or caesarean section for preterm pre-eclampsia.J Obstet Gynaecol 2002; 22:353-356.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn