Complications and maternal mortality from severe pre-eclampsia during the first 48hours in an intensive care unit in Morocco

Autor: Ahmed Mimouni, Hayat Berkhli, Brahim Housni, Yassamine Bentata, Hanane Saadi, Hamid Madani
Rok vydání: 2014
Předmět:
Zdroj: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 129(2)
ISSN: 1879-3479
Popis: Severe pre-eclampsia is a serious pathology of pregnancy because it is associated with a high risk of progression to fatal complications such as eclampsia, HELLP syndrome, retroplacental hematoma, and acute kidney injury, particularly in low-income countries [1]. The first 48 hours after patients have been admitted with severe pre-eclampsia to an intensive care unit (ICU) are crucial, and the quality of management during this period profoundly affects maternal prognosis. The aim of the present study was to determine the clinical and biological characteristics during the first 48 hours after women with severe preeclampsia were admitted to an ICU in Morocco. A retrospective study covering the seven-year period from January 1, 2007, to January 1, 2014, was conducted at the multipurpose ICU at the Regional Hospital of Oujda, eastern Morocco. Ethics Committee approval and informed consent were not needed because of the nature of the study. Inclusion criteria were patients with severe pre-eclampsia at 20weeks or more of pregnancy who had been admitted to the ICU during pregnancy or in the postpartum period (less than seven days after delivery). Severe pre-eclampsia was defined as severe arterial hypertension (systolic ≥160 mm Hg and/or diastolic ≥110 mm Hg), proteinuria (≥2 g/L or≥2+), and/or signs of visceral involvement. Exclusion criteria were pre-existing comorbidities (arterial hypertension, diabetes, nephropathy, and cardiomyopathy). Acute kidney injury was defined using the RIFLE classification (Risk, Injury, Failure, Loss of kidney function, End-stage kidney disease. A total of 138 patients met the criteria and were included in the study. The clinical and biological characteristics at the time of enrollment and the obstetric complications observed during the first 48 hours in the ICU are reported in Table 1. Eclampsia was the main complication of severe pre-eclampsia in the present study. Concerning the frequency of obstetric complications of pre-eclampsia reported in other studies, rates of eclampsia, HELLP syndrome, retroplacental hematoma, and acute kidney injury were reported, respectively, as 43.5%, 27.1%, 24.8%, and 58.7% by Bouazziz et al. [2] and 31.2%, 42.8%, 8.5%, and 19% by Lelong et al. [3]. In Lataifeh et al. [4], maternal mortality related to pre-eclampsia was 17.6% compared with 6.5% in the present study. Hypertensive disorders are themain reason for admission to the ICU in a large number of low-resource countries, which raises the question: what are the risk factors for pre-eclampsia in this population? Prospective studies with more rigorous criteria and methodology are needed.
Databáze: OpenAIRE
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