Prediction of maternal complications and adverse infant outcome at admission for temporizing management of early-onset severe hypertensive disorders of pregnancy

Wessel Ganzevoort, Annelies Rep, Johanna I P de Vries, Gouke J Bonsel, Hans Wolf et al.
American Journal of Obstetrics and Gynecology 2006, 195 (2): 495-503

OBJECTIVE: We explored the association between clinical parameters at admission and the subsequent development of major maternal complications or adverse infant outcome in women with hypertensive complications of pregnancy remote from term.

STUDY DESIGN: We drew data from a randomized trial of temporizing management in 216 patients with hemolysis, elevated liver enzymes, and low platelets syndrome; severe preeclampsia; eclampsia; or hypertension-related fetal growth restriction and gestational ages between 24 and 34 completed weeks. End points were adverse infant outcome (perinatal death, severe morbidity) and major maternal complications (major morbidity; recurrent and newly acquired hemolysis, elevated liver enzymes, and low platelets; eclampsia) after admission. End point prevalences were comparable between the treatment and control groups. The association with age, parity, ethnicity, body mass index, gestational age, estimated fetal weight, blood pressure, antihypertensive medication, pulse rate, hemoglobin concentration, admitting center, diagnosis at inclusion, chronic hypertension, and thrombophilia was explored by logistic regression analysis.

RESULTS: Adverse infant outcome was predominantly influenced by gestational age (odds ratio 0.4 per week increment). Major maternal complications were correlated to multiparity (odds ratio 0.4) and estimated fetal weight (odds ratio 0.9 per 100-g increment).

CONCLUSION: Prediction at admission of the clinical course of the disease and the development of additional maternal complications was not feasible.

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