Using Clinical Symptoms to Predict Adverse Maternal and Perinatal Outcomes in Women With Preeclampsia: Data From the PIERS (Pre-eclampsia Integrated Estimate of RiSk) Study

Yen, T.F.; Payne, Beth; Qu, Zhi; Hutcheon, Jennifer A.; Lee, Tang; Magee, Laura A.; Walters, Barry N J; Dadelszen, Peter von

doi:10.1016/s1701-2163(16)34983-0

Cited by 28 publications

(24 citation statements)

References 8 publications

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“…The sensitivity and specificity of the symptoms in predicting adverse maternal outcomes were, respectively, as follows: Yen et al in an analysis of the PIERS data reported that of 2023 women who underwent assessment, 52 % experienced at least one preeclampsia symptom, with 5.2 and 5.3 %, respectively, experiencing an adverse maternal or perinatal outcome. No single symptom was found to be a good predictor of adverse perinatal outcomes [10].…”

Section: Discussionmentioning

confidence: 94%

Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model

Agrawal

Maitra

2015

J Obstet Gynecol India

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Background This study was conducted to evaluate how the preeclampsia integrated estimate of risk (fullPIERS) model performs in the prediction of adverse maternal outcomes when the predictor variables are all obtained within 24-h of admission for preeclampsia. Methods A prospective cohort study on 323 women who fulfilled definite inclusion and exclusion criteria was conducted. Subjects were monitored for clinical symptoms of preeclampsia, biochemical parameters, and adverse maternal and neonatal outcomes. A risk prediction score was calculated using the fullPIERS calculator. Statistical analysis of rates and ratios was carried out by assessing v 2 test and odds ratio. Results 18.3 % (n = 60) had adverse maternal outcome and 42.8 % (n = 138) had adverse fetal outcome, and 43 (13.35 %) had combined adverse maternal and perinatal outcome. Dyspnea, visual disturbances, epigastric pain, and Sp O 2 appeared to be highly significant risk factors. In the biochemical variables studied, serum creatinine and serum uric acid were found to have a significant association. The association between adverse perinatal outcome and vaginal delivery was highly significant (OR 0.35, 95 % CI 0.19, 0.63), and the P value was 0.0005. The likelihood ratio associated with the highest risk group (predicted probability of the outcome C30 %) showed excellent performance (i.e., 17.5) of fullPIERS model as a rule in test.Shruti Agrawal is a Third-Year Resident; Nandita Maitra is a Professor and Head. 123 Conclusion The fullPIERS model performed well in the prediction of adverse maternal outcomes in women with preeclampsia. It is easy to use. The model is based on the use of few important clinical and biochemical parameters and does not require extensive laboratory testing. Although it might be of limited use in a well-equipped tertiary care facility, this model can be utilized in the setting of district or sub-district level hospitals to identify patients who are at risk of complications due to preeclampsia. Timely referral to a higher center will help in reducing the morbidity and mortality associated with this condition.

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Section: Discussionmentioning

confidence: 94%

Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model

Agrawal

Maitra

2015

J Obstet Gynecol India

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“…Despite advances in the understanding of PE, diagnosing this condition still relies on clinical findings (i.e., hypertension and proteinuria) that are poor markers of disease severity [31] . Indeed, there are cases of normotensive PE or PE without proteinuria in which the pathophysiology and risks are similar to those of classic PE [9] .…”

Section: Characterization Of Atypical Preeclampsiamentioning

confidence: 99%

Characterization of Atypical Preeclampsia

Rojas-Arias

Ortiz-López²,

Orduña-Aparicio³

et al. 2015

Fetal Diagn Ther

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Objective: To characterize patients with atypical preeclampsia (PE), in relation to socio-demographic characteristics, clinical presentation, maternal complications and perinatal outcome. Materials and Methods: Between July 1, 2011 and November 30, 2013, a cohort was created of women attended at a Obstetric High-dependency Unit who met criteria for atypical PE: gestational hypertension with severe hypertension or symptoms or laboratory signs suggestive of microangiopathy/hemolysis; normotensive proteinuria with the presence of symptoms or laboratory signs suggestive of microangiopathy/hemolysis; presence of PE or eclampsia or HELLP syndrome appearing after 48 h postpartum, and, PE or eclampsia appearing before 20 weeks of pregnancy. Results: A total of 200 women fulfilling criteria for atypical PE, were included: 61.5% corresponded to non-proteinuric gestational hypertension, 35.5% to normotensive proteinuria and 3% to PE/eclampsia in late postpartum. Criteria for severe maternal morbidity were present in 12% of the cases and there were no maternal deaths. There were 6 perinatal deaths. Conclusion: Atypical preeclampsia is a type of preeclampsia not fully recognized that is associated with maternal and neonatal morbidity, mainly related to smallness-for-gestational-age and low birth weight. Vasospasm symptoms are a key element to detect this condition.

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“…Specifically, the CLIP intervention consists of:

Community engagement including women from the communities, dyadic household decision-makers (husbands, fathers-in-law) and community leaders about: pre-eclampsia, its origins, symptoms, signs and potential consequences, pre-permissions for maternal transport and fundraising activities for transport and treatment costs;

Provision of HDP-oriented antenatal care through household visits by community healthcare providers (cHCPs) who carry a mobile health (m-health) application for identifying women at risk of pre-eclampsia. The m-health application is programmed with a validated Pre-eclampsia Integrated Estimate of Risk (PIERS) on the Move (POM) [9, 10];

Use of the CLIP package for women with a CLIP ‘trigger’ (i.e. oral antihypertensive therapy or intramuscular (i.m.)…”

Section: Introductionmentioning

confidence: 99%

“…The m-health application is programmed with a validated Pre-eclampsia Integrated Estimate of Risk (PIERS) on the Move (POM) [9, 10];…”

Section: Introductionmentioning

confidence: 99%

The feasibility of community level interventions for pre-eclampsia in South Asia and Sub-Saharan Africa: a mixed-methods design

et al. 2016

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BackgroundGlobally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials prior to implementation. Failure to fully understand the study context risks the effective implementation of the intervention and limits the likelihood of post-trial scale-up. Therefore, it was imperative to conduct community-level feasibility assessments for a trial of this magnitude.MethodsA mixed methods design guided by normalization process theory was used for this study in Nigeria, Mozambique, Pakistan, and India to explore enabling and impeding factors for the CLIP Trial implementation. Qualitative data were collected through participant observation, document review, focus group discussion and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility assessments, self-administered community health worker surveys, and household demographic and health surveillance.ResultsRefer to CLIP Trial feasibility publications in the current and/or forthcoming supplement.ConclusionsFeasibility assessments for community level interventions, particularly those involving task-shifting across diverse regions, require an appropriate theoretical framework and careful selection of research methods. The use of qualitative and quantitative methods increased the data richness to better understand the community contexts.Trial registrationNCT01911494Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0133-0) contains supplementary material, which is available to authorized users.

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Using Clinical Symptoms to Predict Adverse Maternal and Perinatal Outcomes in Women With Preeclampsia: Data From the PIERS (Pre-eclampsia Integrated Estimate of RiSk) Study

Abstract: Maternal symptoms of preeclampsia are not independently valid predictors of maternal adverse outcome. Caution should be used when making clinical decisions on the basis of symptoms alone in the preeclamptic patient.

Cited by 28 publications

References 8 publications

Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model

Prediction of Adverse Maternal Outcomes in Preeclampsia Using a Risk Prediction Model

Characterization of Atypical Preeclampsia

The feasibility of community level interventions for pre-eclampsia in South Asia and Sub-Saharan Africa: a mixed-methods design

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