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Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management.
J Matern Fetal Neonatal Med. 2020 Jan; 33(2):314-321.JM

Abstract

Objective: To assess the relationship between maternal, fetal, and neonatal outcomes and different forms of hypertensive disorders associating pregnancy in women needed intensive care units (ICUs) admission.Methods: A prospective case control study was conducted on 1238 women admitted to hypertensive ICU at three university hospitals. They were classified into four groups. Group I included 472 women with severe preeclampsia (PE), Group II included 243 women with eclampsia (E), Group III included 396 women diagnosed with E associated with HELLP syndrome, and Group IV included 127 women diagnosed as HELLP syndrome. All women received magnesium sulfate to prevent and/or control convulsions and nifedipine to control their blood pressure. Primary outcome parameter was maternal mortality. Other outcomes included maternal morbidities, fetal, and neonatal outcomes.Results: There was a significant difference among the study groups regarding the need for blood transfusion (58.1%, 70%, 84.3%, and 42.5% respectively, p < .001), number of transferred units (2.4 ± 1, 2.9 ± 0.9, 3.4 ± 1.1, and 3.5 ± 0.8 respectively, p < .001), placental abruption (23.3%, 16.5%, 30.3%, and 19.7% respectively, p < .001), pulmonary edema (14.8%, 22.6%, 19.9%, and 34.6% respectively, p < .001), multiple complications (12.5%, 12.3%, 19.9%, and 26% respectively, p < .001), and maternal mortality (1.9%, 4.1%, 6.1%, and 5.5% respectively, p < .001). Regarding fetal and neonatal outcomes, there was a significant difference among the four groups regarding Apgar score at 1 and 5 min, neonatal birth weight, neonatal intensive care unit (NICU) admission, NICU admission days, intrauterine growth restriction, perinatal death, respiratory distress syndrome, intraventricular hemorrhage, sepsis, and the need for mechanical ventilation (p < .001). Higher rate of vaginal delivery was reported in women with HELLP (40.9%) and severe PE (39.8%) and higher rates of performing cesarean section (CS) in women with eclampsia (77.8%). Maternal mortality is significantly related to delivery with CS, younger maternal age with lower parity, and the presence of placental abruption or pulmonary edema. For Groups III and IV, which included HELLP cases, there are significant differences between both groups as regards HELLP classes according to Mississippi classification, also significant differences were seen between both groups as regards, maternal mortality, abruptio placenta, pulmonary edema, multiple organ damage, NICU admission, perinatal deaths, and need for mechanical ventilation.Conclusion: Both maternal mortality and morbidity (placental abruption and need for blood transfusion) are significantly higher in women with HELLP syndrome worsens to become class 1 regardless of whether eclampsia is present or not.Synopsis: Maternal mortality and unfavorable outcome are significantly higher in women with HELLP syndrome whether it was associated with eclampsia or not.

Authors+Show Affiliations

Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Minya University, Minya, Egypt.Obstetrics and Gynecology Department, Minya University, Minya, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Cairo University, Cairo, Egypt.Obstetrics and Gynecology Department, Fayoum University, Fayoum, Egypt.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

29914278

Citation

Maged, Ahmed M., et al. "Maternal, Fetal, and Neonatal Outcomes Among Different Types of Hypertensive Disorders Associating Pregnancy Needing Intensive Care Management." The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, vol. 33, no. 2, 2020, pp. 314-321.
Maged AM, Elsherief A, Hassan H, et al. Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management. J Matern Fetal Neonatal Med. 2020;33(2):314-321.
Maged, A. M., Elsherief, A., Hassan, H., Salaheldin, D., Omran, K. A., Almohamady, M., Dahab, S., Fahmy, R., AbdelHak, A., Shoab, A. Y., Lotfy, R., Lasheen, Y. S., Nabil, H., & Elbaradie, S. M. Y. (2020). Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management. The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 33(2), 314-321. https://doi.org/10.1080/14767058.2018.1491030
Maged AM, et al. Maternal, Fetal, and Neonatal Outcomes Among Different Types of Hypertensive Disorders Associating Pregnancy Needing Intensive Care Management. J Matern Fetal Neonatal Med. 2020;33(2):314-321. PubMed PMID: 29914278.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal, fetal, and neonatal outcomes among different types of hypertensive disorders associating pregnancy needing intensive care management. AU - Maged,Ahmed M, AU - Elsherief,Ameer, AU - Hassan,Hany, AU - Salaheldin,Doaa, AU - Omran,Khaled A, AU - Almohamady,Maged, AU - Dahab,Sherif, AU - Fahmy,Radwa, AU - AbdelHak,Ahmed, AU - Shoab,Amira Y, AU - Lotfy,Rehab, AU - Lasheen,Yossra S, AU - Nabil,Hala, AU - Elbaradie,Sahar M Y, Y1 - 2018/09/09/ PY - 2018/6/20/pubmed PY - 2020/5/30/medline PY - 2018/6/20/entrez KW - Eclampsia KW - HELLP KW - maternal mortality KW - maternal outcome KW - neonatal outcome KW - obstetric intensive care units (ICUs) KW - severe preeclampsia SP - 314 EP - 321 JF - The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians JO - J Matern Fetal Neonatal Med VL - 33 IS - 2 N2 - Objective: To assess the relationship between maternal, fetal, and neonatal outcomes and different forms of hypertensive disorders associating pregnancy in women needed intensive care units (ICUs) admission.Methods: A prospective case control study was conducted on 1238 women admitted to hypertensive ICU at three university hospitals. They were classified into four groups. Group I included 472 women with severe preeclampsia (PE), Group II included 243 women with eclampsia (E), Group III included 396 women diagnosed with E associated with HELLP syndrome, and Group IV included 127 women diagnosed as HELLP syndrome. All women received magnesium sulfate to prevent and/or control convulsions and nifedipine to control their blood pressure. Primary outcome parameter was maternal mortality. Other outcomes included maternal morbidities, fetal, and neonatal outcomes.Results: There was a significant difference among the study groups regarding the need for blood transfusion (58.1%, 70%, 84.3%, and 42.5% respectively, p < .001), number of transferred units (2.4 ± 1, 2.9 ± 0.9, 3.4 ± 1.1, and 3.5 ± 0.8 respectively, p < .001), placental abruption (23.3%, 16.5%, 30.3%, and 19.7% respectively, p < .001), pulmonary edema (14.8%, 22.6%, 19.9%, and 34.6% respectively, p < .001), multiple complications (12.5%, 12.3%, 19.9%, and 26% respectively, p < .001), and maternal mortality (1.9%, 4.1%, 6.1%, and 5.5% respectively, p < .001). Regarding fetal and neonatal outcomes, there was a significant difference among the four groups regarding Apgar score at 1 and 5 min, neonatal birth weight, neonatal intensive care unit (NICU) admission, NICU admission days, intrauterine growth restriction, perinatal death, respiratory distress syndrome, intraventricular hemorrhage, sepsis, and the need for mechanical ventilation (p < .001). Higher rate of vaginal delivery was reported in women with HELLP (40.9%) and severe PE (39.8%) and higher rates of performing cesarean section (CS) in women with eclampsia (77.8%). Maternal mortality is significantly related to delivery with CS, younger maternal age with lower parity, and the presence of placental abruption or pulmonary edema. For Groups III and IV, which included HELLP cases, there are significant differences between both groups as regards HELLP classes according to Mississippi classification, also significant differences were seen between both groups as regards, maternal mortality, abruptio placenta, pulmonary edema, multiple organ damage, NICU admission, perinatal deaths, and need for mechanical ventilation.Conclusion: Both maternal mortality and morbidity (placental abruption and need for blood transfusion) are significantly higher in women with HELLP syndrome worsens to become class 1 regardless of whether eclampsia is present or not.Synopsis: Maternal mortality and unfavorable outcome are significantly higher in women with HELLP syndrome whether it was associated with eclampsia or not. SN - 1476-4954 UR - https://www.unboundmedicine.com/medline/citation/29914278/Maternal_fetal_and_neonatal_outcomes_among_different_types_of_hypertensive_disorders_associating_pregnancy_needing_intensive_care_management_ DB - PRIME DP - Unbound Medicine ER -