Risk factors for maternal death in patients with severe preeclampsia and eclampsia

Abstract

OBJECTIVES: to determine the principal death causes in patients with severe preeclampsia/eclampsia and identify related risk factors. METHODS: a case-control study was performed comprising all cases of maternal death (n = 20) in patients with severe preeclampsia or eclampsia (n = 2.541). 80 controls (survivors) were randomly selected. The odds ratio and an estimate of maternal death relative risk were determined, and a multiple logistic regression analysis performed to determine the adjusted odds ratio. RESULTS: the basic causes for death were: acute pulmonary edema, disseminated intravascular coagulopathy, hemorrhagic shock, pulmonary embolism, acute renal failure, sepsis and three cases of undetermined causes of death. The principal risk factors were: age > 25 years old, multiparity, gestational age < 32 weeks, lack of prenatal care, diastolic pressure > 110mmHg, convulsions, chronic systemic arterial hypertension, HELLP syndrome, pulmonary edema, normally inserted abruptio placenta, disseminated intravascular coagulation, acute renal failure. Variables persistently related to maternal death were: HELLP syndrome, eclampsia, acute pulmonary edema, eclampsia, chronic hypertension and lack of prenatal care. CONCLUSIONS: the principal risk factors for death in women with preeclampsia/eclampsia are the lack of prenatal care, associated to chronic hypertension, HELLP syndrome, eclampsia and acute pulmonary edema.

Proteinúria nas síndromes hipertensivas da gestação: prognóstico materno e perinatal

“…Vários aspectos fazem com que o estudo das síndromes hipertensivas da gestação seja de extrema importância para os clínicos, as pacientes e a comunidade, posto que é a intercorrência clínica mais freqüente na gravidez e, entre as mortes maternas, freqüentemente está implicada, representando a primeira ou a segunda causa nas casuísticas nacionais 25,26 .…”

“…Nas gestantes portadoras de hipertensão gestacional e pré-eclâmpsia a média foi COELHO TM ET AL. 25 anos, portanto, mulheres jovens, saudáveis, passíveis de danos à sua integridade. Sass et al 29 observaram que nas hipertensas crônicas que pariram no Hospital São Paulo, identificaram a idade como variável importante em relação às complicações observadas e que nas gestantes com mais de 40 anos, a incidência de hipertensão foi de 18,8%, versus 2,7% na faixa etária de 20 a 30 anos.…”

implementation of referral system in postpartum hemorrhage cases by midwife

“…According to epidemiological depictions, the credibility of the knowledge generated and the usefulness of the products produced, based on review studies, are closely related to methodological rigidity. This aspect can be qualified through guidelines from the Review Center (Amorim et al, 2001). After carrying out the stages of Critical Appraisal and Data Extraction, five articles that have been selected were assessed for quality by the author using JBI.…”

Risk factors of maternal death in preeclampsia

“…Запоздалая диагностика преэклампсии, запоздалое направление в стационар с выраженной гипертензией, с признаками печеночной недостаточности привели к упущению оптимального времени родоразрешения, что способствовало развитию необратимых изменений в почках, печени, головном мозге. Поступление больных в критическом состоянии увеличивает риск материнской смертности [8]…”