Outcomes of severe pre‐eclampsia/eclampsia in Yorkshire 1999/2003

Abstract

On behalf of the Yorkshire Obstetric Critical Care GroupObjective To establish the risk of serious complications from severe pre-eclampsia and eclampsia in a region using a common guideline for the management of these conditions. Design A five-year prospective study.Setting Sixteen maternity units in Yorkshire.Population All women managed with severe pre-eclampsia and eclampsia.Methods A common guideline was developed for the management of women with these conditions. A network of midwives prospectively collected outcome data. Main outcome measure Incidence of the conditions and serious complication rates.Results A total of 210,631 women delivered in the 16 units between 1 January 1999 and 31 December 2003.One thousand eighty-seven women were diagnosed with severe pre-eclampsia or eclampsia (5.2/1000). One hundred and fifty-one women had serious complications including 82 women (39/10,000) having eclamptic seizures and 49 women (23/10,000) requiring ICU admission. There were no maternal deaths but 54 out of 1145 babies died before discharge, giving a mortality rate of 47.2/1000. Of the 82 cases of eclampsia, 45 occurred antenatally (55%), 18 before admission to the maternity unit. Eleven cases occurred in labour (13%), including 1 during a caesarean section, and 26 cases occurred following delivery (32%). Twenty-five women developed pulmonary oedema (2.3% of cases) and six women required renal dialysis (0.55% of cases). One hundred and sixty-five (15%) required no antihypertensive therapy and 489 (53%) of the remainder required only oral therapy. Two hundred and one (18.5%) required more than one drug. Conclusion A regional guideline for severe pre-eclampsia and eclampsia can be developed and implemented.Its use may contribute to a low rate of serious complications.

Fetomaternal outcome in severe preeclampsia and eclampsia: a retrospective study in a tertiary care centre

“…10 Tufnell et al reported as high as 72% caesarean section rate in BJOG. 12 Caesarean section rates of 71% and 78% respectively were reported by Miguel M et al and Dissanayake VH et al 13,14 The high rate of caesarean section in the present study is due to more than 36 % cases being previous caesarean section and also due to emergency delivery approach taken to prevent further maternal and fetal complications due to severe preeclampsia or eclampsia especially in cases where the cervix is unfavourable for induction.…”

Maternal plasma concentrations of sST2 and angiogenic/anti-angiogenic factors in preeclampsia

“…The frequency of placental lesions [15,52,53], as is the frequency of multisystemic involvement [54][55][56][57], is higher in these patients than those who are diagnosed later. For example, hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome is more common in patients with early-onset disease than in those diagnosed at term [58][59][60].…”

“…The increased perinatal morbidity associated with preeclampsia is also closely linked to early-onset disease because indicated preterm delivery is associated with an increased risk of neonatal complications [61]. Late-onset disease is, however, much more common than early-onset preeclampsia [56,57,62].…”

RETIRED: Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy

“…Oral labetalol (200 mg) has been used with good effect within a regional pre-eclampsia protocol [325]. In a clinical trial of preterm severe hypertension, 100 mg of oral labetalol every 6 h achieved the stated BP goal (of about 140/ 90 mmHg) in 47% of women [326].…”

“…[314]. The phrase, ''planned delivery on the best day in the best way,'' reflects the myriad of considerations regarding timing (and mode) of delivery [325]. Timing delivery will reflect evolving adverse conditions ( Table 2).…”