Effects of Modes and Timings of Delivery on Feto-Maternal Outcomes in Women with Severe Preeclampsia: A Multi-Center Survey in Mainland China

Abstract

Background Pregnancy termination is the only effective treatment for preeclampsia. However, there are controversies on the selection of modes of delivery. The objective was to evaluate whether mode of delivery in labor differentially affected the rate of adverse maternal outcomes related to severe preeclampsia. Objective This study aimed to evaluate whether the modes and timings of delivery affects adverse maternal outcomes in pre-eclampsia. Methods Clinical data from 2516 singleton pregnant women with severe preeclampsia were collected in a multicenter, large-sample, cross-sectional study in mainland China. The patients were divided into cesarean-delivery (CD) and vaginal-delivery (VD) categories and then into Group 1 (≤27 + 6 weeks), Group 2 (28–33 + 6 weeks), Group 3 (34–36 + 6 weeks), and Group 4 (≥37 weeks) according to the mode of delivery and gestational weeks. All data were exported into the SPSS software and analyzed by the Student’s t-tests or Mann–Whitney U -tests and the chi-squared test. Results A total of 2516 singleton pregnant women with severe preeclampsia were collected and the overall cesarean section rate was 84.9%. The vaginal delivery rates among the four groups were significantly different with 70%, 19.7%, 6.6%, 15.1% in groups 1, 2, 3, 4, respectively (P<0.05), while perinatal mortality was lower in the CD groups than VD groups (3.3% vs 50.4%, P<0.05). The neonatal asphyxia rate was significantly higher with CD than with VD in Group 2 (36.4% vs 12.9%, P<0.05). The perinatal mortality with CD, 3, and 4 was significantly lower than with VD (10.0% vs 68.5% in Groups 2, 2.3% vs 28.3% in Groups 3, 0.8% vs 5.6% in Groups 4, all P<0.05). Conclusion Most pregnant women with severe preeclampsia opted for a cesarean section in China. The lower perinatal mortality was associated with cesarean section, but the rate of maternal PPH or mortality was not related with the mode of delivery. So cesarean section is the safer delivery mode for the pregnant women complicated with severe preeclampsia.

Evaluation of outcome of mode of delivery in severe preeclampsia

“…There was no discernible difference between the newborn's APGAR score immediately following delivery and the method of delivery. While the study carried out by Wu et al 9 there was a significant difference between the APGAR Score and mode of delivery was found. A strong association was found between the Bishop score at the time of admission and the mode of delivery after induction.…”

Impact of hypertensive disorders of pregnancy on maternal and neonatal outcomes of twin gestation: a systematic review and meta-analysis

“…The high rates of cesarean sections could be attributed to tendency to perform cesarean sections for mothers with preeclampsia. Studies have reported that up to 85% of women with preeclampsia deliver by cesarean section to reduce the incidence of maternal and neonatal complications ( 31 , 32 ). For neonatal outcomes, HDP was found to increase the risk of low birth weight, SGA, and NICU admission but did not influence Apgar <7 scores.…”

Luaran Maternal Pasien Preeklamsi Berat Awitan Dini Dan Lambat Berdasarkan Metode Persalinan

“…Oleh karena itu, tidak ada konsensus yang diperoleh tentang cara persalinan yang lebih disukai pada wanita hamil dengan preeklampsia berat. 8 Pada penelitian Hutabarat dkk pada tahun 2016 didapatkan bahwa ibu yang pendidikannnya tinggi maupun berpendidikan rendah memiliki kesempatan yang sama untuk terkena preeklamsi. 2 Berdasarkan penelitian Nuning dan Mardiana tahun 2014, didapatkan tidak signifikannya hubungan pekerjaan ibu dengan kejadian preeklamsi, hal ini dikarenakan sesuai hasil penelitian bahwa pekerjaan lebih berhubungan dengan tingkat stress, jadi ibu hamil yang tidak bekerja juga bersesiko mengalami preeklamsi dalam kehamilan karena sebagai IRT juga mengalami stres.…”

“…Studi ini juga menegaskan bahwa angka sectio caesarea pada preeklamsi berat mencapai 84,9%, konsisten dengan laporan sebelumnya. 8 Pada penelitian Amorim et al tahun 2014 mendapatkan sebagian besar angka kejadian sindrom HELLP menjalani metode persalinan sectio caesarea. Menurut teori, wanita dengan preeklamsi dan sindrom HELLP biasanya memiliki luaran yang lebih buruk daripada ibu preeklamsi tanpa sindrom HELLP.…”