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Contributing factors of neonatal death from mother with preeclampsia in Indonesia
Abstract
Background: Preeclampsia is one of the main causes of maternal and neonatal morbidity and mortality in developing countries. The infant mortality rate in Indonesia has decreased but is still quite high. The purpose of this study was to analyze the factors that contribute to the death of infants from mothers with preeclampsia. Method: This research is a design retrospective cross-sectional study conducted in women of delivery) and infant mortality data were collected which were then analyzed descriptively and chi-square test. Results: The results showed a significant relationship between maternal age with preeclampsia (p = 0.005), age of maternal pregnancy with preeclampsia (p = 0.000) and mode of delivery of mothers with preeclampsia (p = 0.000) with the incidence of death in infants, and none a significant relationship between maternal parity status with preeclampsia (p = 0.043) with the incidence of death in infants. Conclusion: factors that contribute to infant mortality from mothers with preeclampsia are age, gestational age, and mode of delivery. © 2018, Indian Journal of Public Health Research and Development. All rights reserved.
... Aged 20-35 years are women at low risk of pregnancy compared to those above 35 years old. Mothers over 35 years old have a seven times higher risk compared to 20-35 years old (16,17). Advanced age more than 35 years old has undergone degenerative function in the reproductive system that results in the disruption of trophoblast invasion into the delicate layer of a blood vessel, the emergence of immunological reactions and free radicals. ...
... However, another study in contrast with this finding in Indonesia stated that out of 324 pregnant women with high blood pressure, 211 women (65%) were aged 20-35 years old, whereas 113 women (35%) were aged <20 and >35 years old. Even though 20-35 years old is considered low risk, multiple pregnancies (multipara) contribute to preeclampsia (17). There are more factors contributing to preeclampsia among 20-35 years old mothers with pregnancy interval between 2-10 years, obesity with (84 out of 216 respondents or 39%) and obesity which IMT 30 or more (102 out of 216 respondents or 48%) (19). ...
Hypertension in pregnancy is among the three highest complications in 1 in 10 pregnant women. It is a significant cause of morbidity and mortality for mothers and babies (including seizures and low birth weight (LBW)). Earthing or grounding is a direct contact therapy between the body and the earth's surface (soil, grass, sand or stone), which allows the free transport of electrons from the earth's surface to spread to the body through the skin. The research objective was to analyze the effect of Earthing on hypertension in pregnancy. The research design was a pre-experimental with a one-group pretest and posttest, designed for one year of study. The population of pregnant women with hypertension in Surakarta City, Central Java, with the sampling technique used was purposive sampling, recruiting 20 respondents. Earthing duration 1 hour every day for 30 days. The statistical analysis results in a P-value of 0.000, t-count 25.065>t-table 2.093, for systolic blood pressure and P-value 0.000, t-count 93.05>t-table 2.093 for diastolic blood pressure. It indicates a significant difference in pregnant mothers' systolic and diastolic blood pressure before and after Earthing. It is recommended for mothers to perform Earthing or grounding as a lifestyle medicine at home by placing bare feet on the soil every day for 1 hour. It is beneficial to do Earthing/grounding throughout the pregnancy or by using Earthing device that connects the electrons in the earth to the skin.
... It was found that parity is one of the determinants of neonatal death. Multiparous women have a higher risk of possibility than multiparous women [14][15] [16]. ...
Antenatal care (ANC) is an effective way to prevent neonatal death. The study was aimed at analyzing antenatal care as a predictor of neonatal death in rural Indonesia. This study uses secondary data from the 2017 Indonesia Demographic and Health Survey (IDHS). Stratification and multistage random sampling yielded 19,283 women aged 15-49 years with live births in the last 5 years in rural Indonesia. Data were analyzed using a Binary Logistic Regression test. Women in rural Indonesia who did ANC ≥ 4 times had a 0.424 times chance of experiencing neonatal death compared to women who did ANC < 4 times. Women in rural Indonesia who were not employed have the possibility of 0.472 times to experience neonatal death compared to employed women. Primiparous women in rural Indonesia were 0.435 times more likely to experience neonatal death than multiparous women. Women in rural Indonesia who did not experience complications during pregnancy were 0.551 times more likely to experience neonatal death than women who experienced complications during pregnancy. It was concluded that ANC is a predictor of neonatal death in rural Indonesia. Other variables that were proven to be predictors were employment status, parity, and complications during pregnancy.
... The results of his analysis show that although primiparous women have lower odds ratios than multiparous women, the difference in parity between primiparous and multiparous is not a predictor of neonatal death in Indonesia. The results of this study are different from other studies, which found that parity is one of the determinants of neonatal mortality 6,7,8 . Table 2 shows that there are three significant variables as predictors of neonatal death in Indonesia. ...
One factor that is thought to have a close relationship with neonatal deaths is parity. This is a problem for Indonesia which has the cultural characteristics of a large number of children is something positive. The study used the 2017 IDHS data. With stratification and multistage random sampling, 36,548 women aged 15-49 years with live births in the last 5 years were sampled. The final analyzed using a Binary Logistic Regression test. Multiparous women in Indonesia have a higher percentage of neonatal deaths than multiparous women. But the difference in parity between primiparous and multiparous was found not to be a predictor of neonatal death in Indonesia. Three other variables were found to be proven, predictors. Women who were not employed were 0.576 times more likely than women employed for neonatal death (OR 0.576; 95% CI 0.407-0.814). Women who did antenatal care ≥4 times were 2.332 times more likely than women who had ANC <4 times to experience neonatal death (OR 2.332; 95% CI 1.519-3.578). Women who did not experience a complication during delivery were 0.457 times more likely than women who had a complication during delivery for neonatal death (OR 0.457; 95% CI 0.317-0.659). The study concluded that parity was not a predictor of neonatal death in Indonesia. Other variables that were proven to be predictors are employment status, antenatal care, and complications during pregnancy.
Objectives
This study explores the impact of early motherhood on neonatal mortality, and how this differs between countries and regions. It assesses whether the risk of neonatal mortality is greater for younger adolescent mothers compared with mothers in later adolescence, and explores if differences reflect confounding socio-economic and health care utilisation factors. It also examines how the risks differ for first or subsequent pregnancies.
Methods
The analysis uses 64 Demographic and Health Surveys collected between 2005 and 2015 from 45 countries to explore the relationship between adolescent motherhood (disaggregated as <16 years, 16/17 years and 18/19 years) and neonatal mortality. Both unadjusted bivariate association and logistic regression are used. Regional level multivariate models that adjust for a range of socio-economic, demographic and health service utilisation variables are estimated. Further stratified models are created to examine the excess risk for first and subsequent births separately.
Findings
The risk of neonatal mortality in all regions was markedly greater for infants with mothers under 16 years old, although there was marked heterogeneity in patterns between regions. Adjusting for socio-economic, demographic and health service utilisation variables did not markedly change the odds ratios associated with age. The increased risks associated with adolescent motherhood are lowest for first births.
Conclusion
Our findings particularly highlight the importance of reducing adolescent births among the youngest age group as a strategy for addressing the problem of neonatal mortality, as well ensuring pregnant adolescents have access to quality maternal health services to protect the health of both themselves and their infants. The regional differences in increased risk are a novel finding which requires more exploration.
To estimate gestational age-specific risks of fetal death in pregnancies complicated by preeclampsia.
Population-based cohort study comprising all singleton births (N=554,333) without preexisting chronic hypertension recorded in the Norwegian Medical Birth Registry from 1999 to 2008. Additional data come from a subset of preeclamptic pregnancies enrolled in the Norwegian Mother and Child Cohort Study with available medical records (n=3,037). The risk of fetal death, expressed per 1,000 fetuses exposed to preeclampsia, was calculated using a life table approach.
Preeclampsia was recorded in 3.8% (n=21,020) of all pregnancies. Risk of stillbirth was 3.6 per 1,000 overall and 5.2 per 1,000 among pregnancies with preeclampsia (relative risk 1.45, 95% confidence interval [CI] 1.20-1.76). However, relative risk of stillbirth was markedly elevated with preeclampsia in early pregnancy. At 26 weeks of gestation, there were 11.6 stillbirths per 1,000 pregnancies with preeclampsia compared with 0.1 stillbirths per 1,000 pregnancies without (relative risk 86, 95% CI 46-142). Fetal risk with preeclampsia declined as pregnancy advanced, but at 34 weeks of gestation remained more than sevenfold higher than pregnancies without preeclampsia.
For clinical purposes, the fetal risk of death associated with preeclampsia begins when preeclampsia becomes clinically apparent. Using a method that takes into account the clinical diagnosis of preeclampsia and the population of fetuses at risk, we find a remarkably high relative risk of fetal death among pregnancies diagnosed with preeclampsia in the preterm period. LEVEL OF EVIDENCE:: II.
Pre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes.
We performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels.
Data for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%). At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI), nulliparity (AOR: 2.04; 95%CI 1.92-2.16), absence of antenatal care (AOR: 1.41; 95%CI 1.26-1.57), chronic hypertension (AOR: 7.75; 95%CI 6.77-8.87), gestational diabetes (AOR: 2.00; 95%CI 1.63-2.45), cardiac or renal disease (AOR: 2.38; 95%CI 1.86-3.05), pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03-1.24) and severe anemia (AOR: 2.98; 95%CI 2.47-3.61) were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83-0.98). Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight.
Chronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia/eclampsia. Implementation of effective interventions prioritizing risk factors, provision of quality health services during pre-pregnancy and during pregnancy for joint efforts in the areas of maternal health are recommended.
Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.
To evaluate maternal and perinatal outcome in nulliparious women complicated with pregnancy hypertension.
This descriptive-analytic and case-control study was performed on 100 hypertensive and 100 normotensive nulliparious women who were referred to Imam Reza hospital in 2008. They were compared for maternal and perinatal outcomes. The data was analyzed by SPSS software. P < 0.05 was considered statistically significant.
In this study, there were no significant differences in maternal age, menstruation condition, delivery mode, placental detachment rate between the studied groups. Gestational age was significantly lower in the case group, especially in severe preeclampsia subgroup (P < 0.001). Serum creatinine level more than 1.2 mg/dl was significantly higher in mild and severe preeclampsia groups (P = 0.018). Significant differences were found in neonatal APGAR, need of rescusitation, NICU admission, birth weight and length, LBW and intrauterine growth retardation between the studied groups.
The results of this study revealed that maternal and foetal-neonatal complications mostly appear in pregnancy complicated with induced hypertension especially in severe preeclampsia.
Preeclampsia is a pregnancy-specific hypertensive syndrome associated with significant morbidity and mortality in mother and neonate. We compared neonatal and maternal complications in preeclamptic women with healthy pregnant women.
All 125 consecutive women with preeclampsia at Bandarabbas Shariati Hospital were assessed between July 2005 and July 2006. Parity, type of delivery, common causes of cesarean section, gestational age, birth weight, and neonatal complications and mortality were included as study variables and compared with the control group.
Cesarean section rates were significantly higher in the group with preeclampsia than in the control group (p < 0.05). The mean parity was higher in the normotensive group than in the preeclamptic patients (2.3 +/- 0.65 vs. 3.6 +/- 0.74; p < 0.05). In the preeclamptic women undergoing vaginal delivery, 31% of them underwent induction of labor. The most common indication for induction of labor was severity of preeclampsia (77.8%). Birth weight was statistically significantly lower in women with preeclampsia (p < 0.0001). Among the patients, 5.6% of them were admitted with intrauterine fetal demise, while 111 neonates survived for the remaining patients. The most common causes of neonatal mortality were congenital abnormalities and respiratory distress syndrome.
Gestational age, parity, cesarean section rate, the rate of induced labor, and low birth weight neonates were more frequent in preeclamptic women than in healthy pregnant women.
Objective:
To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation.
Design:
Nationwide case series.
Setting:
All Dutch tertiary perinatal care centres.
Population:
All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014.
Methods:
Women were identified through computerised hospital databases. Data were collected from medical records.
Main outcome measures:
Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival).
Results:
We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days.
Conclusions:
Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling.
Tweetable abstract:
Severe early onset pre-eclampsia comes with high maternal complication rates and poor neonatal survival.
Preeclampsia is characterized by alterations in angiogenic factors that may increase neonatal morbidity independent of preterm birth.
We estimated the controlled direct effect of preeclampsia on neonatal outcomes independent of preterm birth among 200,103 normotensive and 10,507 preeclamptic singleton pregnancies in the Consortium on Safe Labor (2002-2008). Marginal structural models with stabilized inverse probability weights accounted for potential confounders in the pathway from preeclampsia to preterm birth to neonatal outcomes, including mediator-outcome confounders related to preeclampsia status, such as cesarean delivery. Controlled direct effects of preeclampsia on perinatal mortality, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, respiratory distress syndrome, transient tachypnea of the newborn, anemia, apnea, asphyxia, peri- or intraventricular hemorrhage, and cardiomyopathy were estimated for the hypothesized intervention of term delivery for all infants.
When delivery was set at ≥37 weeks, preeclampsia increased the odds of perinatal mortality (odds ratio = 2.2 [95% confidence interval = 1.1-4.5], SGA = (1.9 [1.8-2.1]), NICU admission (1.9 [1.7-2.1]), respiratory distress syndrome (2.8 [2.0-3.7], transient tachypnea of the newborn (1.6 [1.3-1.9]), apnea (2.2 [1.6-3.1]), asphyxia (2.7 [1.5-4.9]), and peri- or intraventricular hemorrhage (3.2 [1.4-7.7]). No direct effect of preeclampsia at term was observed for anemia or cardiomyopathy. Our results appear robust in the presence of moderate confounding, and restriction to severe preeclampsia yielded similar findings.
Preeclampsia was directly associated with adverse neonatal outcomes beyond morbidity mediated by preterm birth. Although severe neonatal outcomes were less common at later gestational ages, marginal structural models suggested elevated neonatal risk due to preeclampsia even if it was possible to deliver all infants at term.
Objective:
To test the hypothesis that the risk of preeclampsia in nulliparous women may be due to an anti-angiogenic state.
Methods:
Maternal serum samples obtained in the third trimester from nulliparous (n = 86) and multiparous (n = 165) singleton uncomplicated pregnancies were analyzed for levels of angiogenic factors - soluble fms like tyrosine kinase 1 (sFlt1) and placental growth factor (PlGF) by enzyme-linked immunosorbent assay (ELISA).
Results:
For nulliparous and multiparous pregnancies, serum sFlt1 levels were 12 732 ± 832 and 10 162 ± 666 (p = 0.020), serum PlGF levels were 215 ± 15 and 249 ± 14 (p = 0.093) (all reported as mean SD in pg/ml) and mean ratios of sFlt1/PlGF were 93 ± 12 and 62 ± 5 (p = 0.023), respectively. Adjustment for maternal age and fetal birth weight did not alter the results.
Conclusions:
Nulliparous pregnancies had higher circulating sFlt1 levels and sFlt1/PlGF ratios than multiparous pregnancies, suggesting an association with an angiogenic imbalance. Taken together with the pathogenic role of anti-angiogenic factors in preeclampsia, our data may be one explanation for the epidemiological observation that nulliparity is a risk factor for the development of preeclampsia.
To determine the maternal and perinatal outcome after expectant management of severe pre-eclampsia between 24 and 34 weeks of gestation.
The maternal and fetal status was monitored by an intensive, non-invasive method among 94 women with severe pre-eclampsia between 24 and 34 weeks of gestation who were scheduled for expectant management in the OICU at a tertiary care center. Pregnancy prolongation and maternal and perinatal morbidity and mortality were analyzed by the Student 't' test and the Mann-Whitney U test.
The days of pregnancy prolongation and perinatal mortality were significantly higher among those managed at <30 weeks. Increasing gestational age correlated with a reduction of RDS. Maternal morbidities were significantly higher among those managed at <28 weeks. But, there was no maternal mortality.
Expectant management of severe pre-eclampsia at 30-34 weeks in a tertiary care center of a developing country is associated with good perinatal outcome and risk reduction for the mother.
Background
Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Present study was planned to find the maternal and perinatal outcome in patients of severe pre-eclampsia and eclampsia.
Methodology
It is a prospective study, carried out on 100 pregnant women admitted with severe pre-eclampsia and eclampsia at a tertiary care referral unit. Detailed history and examination was carried out. Investigations like complete hemogram, liver function tests, renal function tests, coagulation profile, fundus and 24 hours urine for protein were done. Obstetric management was done as per existing protocol in the department, magnesium sulphate was the drug of choice for controlling convulsions, and blood pressure was controlled either by oral nefidipene or methyl dopa. Maternal and perinatal complications were noted down.
Results
The majority of the patients was unbooked (82%), belonged to lower socioeconomic status (84%) and had rural background (84%). Headache was the most common antecedent symptom (44%) followed by epigastric pain (20%), oliguria (9%), blurring of vision (8%) and ascitis (5%). There was high incidence of maternal complications like PPH (31%), abruption placentae (11%), renal dysfunction (8%), pulmonary edema (8%), pulmonary embolism (4%), HELLP syndrome (2%) and DIC (2%). Maternal mortality was 8% and the causes were pulmonary embolism in four women, DIC in two, HELLP and pulmonary edema in one each. Perinatal complications were also high 71.43% were low birth weight, 66% had preterm delivery, 52.4% babies had birth asphyxia and 28.57% were still born. Maternal and perinatal outcome was much poorer in eclampsia as compared to severe pre-eclampsia.
Conclusion
There is a very high maternal and perinatal morbidity and mortality and 82% patients had no antenatal care. Good antenatal care could have been prevented severe pre-eclampsia and eclampsia to some extent. Thus it is suggested that developing countries have to go a long way to create awareness about importance of antenatal check ups and take measures for implementation.
We sought to determine perinatal outcome and maternal morbidities based on gestational age (GA) at onset of expectant management in severe preeclampsia (PE) between 27(0/7) and 33 (6/7) weeks. In this retrospective analysis of outcome in patients with severe preeclampsia, we studied 66 patients (71 fetuses) with severe PE at 27 (0)/ (7) to 33(6/ 7). All patients received corticosteroids. Perinatal and maternal complications were analyzed. Five patients had twin gestations. Median for days of prolongation was 5 days (range, 3 to 35). Birth weights of 19 (27%) were < 10% for gestational age, and 6 (8%) were < 5%. All fetuses survived except for one neonatal death at 27 weeks, and three infants had chronic lung disease-two at 27 and one at 28 weeks-but there were no cases of intraventricular hemorrhage (>or= grade ?). Rate of abruption was significantly higher at 27 to 28 weeks as compared with > 28 weeks (25% vs 6%, p = 0.05). There was no eclampsia, and two had transient renal insufficiency at 27 weeks. Four of 11 (36%) patients with expectant management at >or= 32 weeks had pulmonary edema or hemolytic anemia, elevated liver enzymes, and low platelet count. During expectant management, rate of respiratory distress syndrome and other serious neonatal complications decrease with increasing GA, supporting a role for such management in early severe preeclampsia. Because there is significant maternal morbidity at >or= 32 weeks with minimal neonatal benefit, consideration should be given for delivery of these pregnancies following corticosteroid administration.
Hypertension and proteinuria in pregnancy may be the result of a number of different disorders with different etiologies and pathologic characteristics. As the causes of hypertension and proteinuria in pregnancy are largely unknown, a new clinical classification of the hypertensive disorders is proposed and is based solely on the physical signs of hypertension and proteinuria. The classification is intended to define meaningful clinical categories by which all cases of hypertension and proteinuria occurring in pregnancy, labor, or the puerperium may be classified. New definitions of hypertension and proteinuria are also proposed; they are based on standardized methods of measurement and simple criteria of abnormality. It is hoped that this clinical classification and associated definitions will find general acceptance so that the incidence and outcome of the hypertensive disorders of pregnancy and the results of research in different centers may be compared and mutual understanding achieved.
We sought to characterize predictors of neonatal outcome in women with severe preeclampsia or eclampsia who were delivered of their infants preterm.
We performed a retrospective analysis of 195 pregnancies delivered between 24 and 33 weeks' gestation because of severe preeclampsia or eclampsia. Multiple logistic regression and univariate chi(2) analysis were performed for the dependent outcome variables of survival and respiratory distress syndrome by use of independent fetal and maternal variables. A P value of <.05 was considered significant.
In the multivariate analysis, respiratory distress syndrome was inversely related to gestational age at delivery (P =.0018) and directly related to cesarean delivery (P =.02), whereas survival was directly related to birth weight (P =.00025). There was no correlation in the multivariate analysis between respiratory distress syndrome or survival and corticosteroid use, composite neonatal morbidity, mean arterial pressure, eclampsia, or abruptio placentae. In the univariate analysis respiratory distress syndrome was associated with cesarean delivery (odds ratio, 7.19; 95% confidence interval, 2. 91-18.32). The incidence of intrauterine growth restriction increased as gestational age advanced. Furthermore, intrauterine growth restriction decreased survival in both the multivariate (P =. 038; odds ratio, 13.2; 95% confidence interval, 1.16-151.8) and univariate (P =.001; odds ratio, 5.88; 95% confidence interval, 1. 81-19.26) analyses.
The presence of intrauterine growth restriction adversely affected survival independently of other variables. Presumed intrauterine stress, as reflected by the severity of maternal disease, did not improve neonatal outcome.
This study was designed to determine whether immediate cesarean delivery for patients with severe preeclampsia confers any benefit to the mother or neonate.
This retrospective chart review included all deliveries complicated by severe preeclampsia between July 1, 1999, and June 30, 2000. Cesarean deliveries performed for malpresentation, previous classic incision, multiple gestation, placenta previa, and herpetic outbreak were not included. Demographic variables, maternal outcomes, and neonatal outcomes were collected.
Of 114 patients, 93 had an option regarding route of delivery. Thirty-four had an immediate cesarean section and 59 had induction of labor. Thirty-seven of 59 were delivered vaginally and 22 of 59 underwent cesarean delivery. Pulmonary complications in the mother and neonate were more common in cesarean delivery (P <.05). No morbidity was decreased by cesarean delivery. Bishop score and gestational age did not affect the labor induction success rate.
Immediate cesarean delivery confers no benefit to patients with severe preeclampsia.
The purpose of this study was to evaluate placental lesions found in women with preeclampsia compared with normotensive control subjects and to determine whether the presence of these lesions are related to gestational age at delivery.
Placental disease of women with preeclampsia at 24 to 42 weeks of gestation was compared with the placental disease of normotensive gestational age-matched control subjects. The placental lesions that were studied specifically included decidual arteriolopathy, thrombi in the fetal circulation, central infarction, intervillous thrombi, and hypermaturity of villi. Data analysis involved the chi(2) test, the Student t test, and logistic regression; odds ratios and CIs were estimated.
Placentas from women with preeclampsia (n=158) and normotensive control subjects (n=156) were evaluated. Among women with preeclampsia, 67% had severe disease. Placental lesions were studied according to gestational age at delivery: <28, 28 to 32, 33 to 36, and >or=37 weeks of gestation. Of the placental lesions that were studied, decidual arteriolopathy (odds ratio, 23.8, 95% CI 10.0-57.0), hypermaturity of villi (odds ratio, 12.4; 95% CI 5.3-29.2), intervillous thrombi (odds ratio, 1.95;95% CI 1.0-3.7), central infarction (odds ratio, 5.9; 95% CI 3.1-11.1), and thrombi in the fetal circulation (odds ratio, 2.8; 95% CI 1.2-6.6) were found to have significantly higher rates in the preeclamptic group. In contrast, the rate of chorioamnionitis was significantly lower in the preeclamptic group (odds ratio, 0.2; 95% CI 0.1-0.4). The rates of abruptio placentae and meconium staining were not different between the two groups. Within the preeclamptic group, the rates of decidual arteriolopathy (P<.0001), central infarction (P=.0001), and hypermaturity of villi (P<.0001) were higher the earlier the gestational age at delivery.
Placentas in women with preeclampsia have increased amounts of disease. The rate is increased with lower gestational ages at the time of delivery for women with preeclampsia.
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