@2024 Afarand., IRAN

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ISSN: 2251-8215    Sarem Journal of Reproductive Medicine 2019;3(2):71-75

Background
Preeclampsia and eclampsia are among the 5 leading causes of maternal mortality and morbidity [1, 2].
Previous Studies
… [3-15]. A systematic review in developing countries showed that maternal mortality was 4 times higher in preeclampsia patients. Also, in preeclamptic mothers, a higher rate of fetal death, hospitalization of the neonate in the intensive care unit (ICU), and preterm labor have been reported [16]. In the United States in 2012, the probability of preeclampsia mothers’ suffering from at least one maternal complication is 10.1% compared to 4.6% in non-preeclamptic mothers and the probability of infants’ suffering from at least one neonatal complication is 14.2% compared to 7.9%; in addition, it has reduced preeclampsia by 1.7 weeks [17].
Aim(s)
This study was conducted with the aim of investigating properties and maternal and fetal complications in preeclampsia patients.
Research type
The present study is a descriptive-analytical cross-sectional.
Research society, place and time
The patients, who were referred to the Sarem Hospital diagnosed with preeclampsia from April 2010 to February 2015 and were hospitalized for termination of pregnancy
Sampling method and number
All 195 patients, were selected by the Census method.
Used devices&materials
Data collection was based on patient records, and pre-designed checklists were filled out on the documentation of the records. Preeclampsia is defined according to the 10th edition of Danforth's book [18]. The variables of the study included demographic characteristics of the patients, pregnancy and fertility status, maternal field diseases, history of preeclampsia, high levels of amniotic fluid (presence of polyhydramnios), systolic and diastolic blood pressure measured at the time of admission, symptoms of preeclampsia and eclampsia such as headache, nausea, vomiting, stomach pains (epigastric region), visual disorders and seizures, liver enzymes at the time of admission, platelets, creatinine, uric acid, lactate dehydrogenase (LDH), presence or absence of maternal oliguria, protein excretion in 24-hour urine (in cases where the variable is measured), a review of maternal and fetal complications, length of hospital stay before the termination of pregnancy, method of termination of pregnancy, maternal postpartum hospital stay, neonate Apgar, gestational age at the time of termination of pregnancy, the presence or absence of HELLP syndrome, and fetal gender. The data were analyzed by SPSS 19 software, using Chi-square, Fisher exact, and T-paired tests.
Findings by Text
51.8% of the neonates were male and 48.2% were female. The mean systolic blood pressure in the patients was 147.92±8.43 with a maximum of 180mmHg and minimum of 110mmHg and the mean diastolic blood pressure was 91.15±8.95 with a maximum of 115 and minimum of 60. The most common symptom of the patients was a headache observed in 28.7% of them. 8.7% of the patients had nausea, 3.1% had vomiting, 9.7% suffered from epigastric pain, 4.6% had visual disorders, and 0.5% (only 1 patient) had seizure and eclampsia. 63.9% of patients were asymptomatic. 14.1% of the patients had liver enzymes (SGOT and SGPT) disorder, 19.6% had less than 150,000 platelets, and 62.7% of them had abnormal Lactate dehydrogenase. In all patients, creatinine was in normal range, and none had oliguria. 64.6% of the patients had proteinuria +1, 21.5% had proteinuria +2, 13.3% had proteinuria +3, and 0.5% (1 patient) had +4 proteinuria. 24-hour proteinuria was not measured in all patients, but in the measured cases, the mean was 806.35mg. Maternal complications were reported in 8 patients as 4.1%. The most common complications were placental abruption and HELLP syndrome, each of which was observed in 2.1% (4 patients). One of the patients had intracerebral hemorrhage (ICH). There were no cases of renal complications, fluid accumulation in the lung (pulmonary edema), and encephalopathy without structural causes. Fetal complications were present in 26.2% of the patients. The most common fetal complications were fetal distress and intrauterine growth restriction, that the frequency of both 12.3% (24 cases) was reported. 5.1% of neonates (10 neonates) were preterm labor, 3.6% had meconium excretion, and in 1 case, intrauterine fetal death (IUFD) was reported a 29-week-old fetus diagnosed with placental abruption and her mother had HELLP syndrome. The mean maternal hospitalization was 0.63 days before the termination of pregnancy and 2.5 days after delivery. The mean 1-minute Apgar score was 8.37 (±1.32) and the mean 5-minute Apgar score was 9.48 (±1.19). Among all patients, one case with vaginal delivery and the rest with cesarean section terminated the pregnancy. Among the field diseases, patients with the antiphospholipid syndrome were associated with increased maternal complications as 3.1% of them had complications, while complications were observed in 1% of the patients without this syndrome, but there was no significant relationship between this syndrome in mother and fetal complications (p=0.1). In this study, there was no significant relationship between diabetes, critical high blood pressure, and a history of preeclampsia and maternal and fetal complications (p>0.05). Of 8 cases of maternal complications, 6 cases were in the symptomatic mothers' group and 2 cases were in the asymptomatic group. Symptomatic mothers had maternal and fetal complications more than asymptomatic mothers, but this relationship was not significant (p>0.05). The low gestational age had a significant relationship with the increase in fetal complications so that the gestational age was 35.6% for complicated fetuses and 37.2% for uncomplicated fetuses (p=0.001). Among laboratory indices, Lactate dehydrogenase was associated with a significant increase in maternal (p=0.001) and fetal (p=0.004) complications, so that the mean of this index was 2235.38 in complicated mothers and 384.61in uncomplicated mothers, while in fetal complications, these numbers were reported 385.35 and 375.02, respectively. The mean liver enzymes was higher in patients with maternal complications, so that the mean serum glutamic-oxaloacetic transaminase (SGOT) was 49.5 in patients with maternal complications and 26.94 in patients without maternal complications (p=0.043), and the mean serum glutamate-pyruvate transaminase (SGPT) was 60.13% in complicated mothers and 23.87 in uncomplicated mothers, and this relationship was statistically significant (p=0.001). There was no significant relationship between platelet count and maternal and fetal complications (p>0.05).
Main comparison to the similar studies
According to the World Health Organization report, the mortality and morbidity rate of mothers with preeclampsia was 0.43% and 36.6% for fetal mortality in developing countries [16]. The rate of fetal mortality was about 12-times lower (0.5%) in Sarem Hospital. This was lower compared to a study conducted in California between 2008 to 2011, and a study presented in 2012 that reporting fetal mortality due to preeclampsia as 1.8% [17]. In this study, the most common fetal complications were fetal distress and intrauterine growth restriction with 12.3% frequency, and, totally, 26.2% of them were complicated. In a study conducted by Stevens et al. the fetal distress was 2.6% [17].
Suggestions
It is suggested to investigate some maternal complications such as postpartum hemorrhage in future studies. In addition, other fetal complications such as sepsis, respiratory distress syndrome, neonatal necrotizing enterocolitis, and other fetal complications in preeclampsia mothers should also be considered.
Limitations
One of the limitations of this study is the defect of some records, which made it impossible to evaluate some variables, such as the level of uric acid with regard to the lost data.
Conclusions
The levels of liver enzymes and the presence of antiphospholipid syndrome are considered as predictors of maternal complications, while Lactate dehydrogenase and symptomaticity of the mother are predictors of maternal and fetal complications.
Acknowledgments
None declared by the authors.
Conflict of interest
None declared by the authors.
Ethical Permissions
None declared by the authors.
Funding Sources
None declared by the authors.