Risk factors of maternal death in preeclampsia

Aim. To determine the factors contributing to maternal death due to preeclampsia.Materials and Methods. We performed a retrospective study of 149 maternal deaths from preeclampsia during 2013-2017, which included the analysis of birth histories, medical records, individual observation cards, outpatient records, and questionnaires of healthcare workers and relatives.Results. Preeclampsia was responsible for 24.1% of maternal deaths over 5 years (2013-2017). The causes of death in women with preeclampsia were: pulmonary oedema (33/149, 22.2% cases), acute renal failure (33/149, 22.2%), cerebral complications (43/149, 28.6%), and hepatic impairment (acute fatty liver of pregnancy or HELLP syndrome, 45/149, 30.2%). The majority of pregnant women admitted in critical condition because of acute fatty liver of pregnancy or HELLP syndrome (45/149, 30.2%), eclampsia at home (25/149, 16.8%), or severe hypertension (114/149, 76.5%). The majority of those who died from preeclampsia had premature births (86/149, 57.7%) and delivered by caesarean section (117, 78.5%), yet the latter was associated with a higher risk of maternal death in case of preeclampsia (OR = 30.028. 95% CI = 15.277-59.022) as compared with vaginal delivery. Risk factors of the maternal death in preeclampsia included late hospitalization (66% of deaths), inadequate antenatal care (64.4%), incorrect route of examination and hospitalization (31.6%), underestimation of the patient's condition (42.3 %), insufficient monitoring during pregnancy, childbirth and post childbirth (48.8%), and insufficient teamwork of medical staff (42.2%).Conclusions. Insufficient knowledge of preeclampsia symptoms by pregnant women and their families, insufficient monitoring of blood pressure, underestimation of organ dysfunction, late hospital admission, late delivery, insufficient antihypertensive therapy, delivery at elevated blood pressure, and insufficient teamwork of healthcare professionals increase the risk of maternal mortality in the patients with preeclampsia.

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Pregnancy-related liver pathology: hyperemesis gravidarum, cholestatic hepatosis of pregnancy, preeclampsia/eclampsia, HELLP-syndrome, acute fatty liver of pregnancy

Reproductive health of woman ◽

10.30841/2708-8731.1.2021.229699 ◽

2021 ◽

Vol 1 ◽

pp. 7-16

Author(s):

О.V. Golyanovskiy ◽

N.E. Geints ◽

V.V. Mekhedko ◽

S.V. Frolov

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Pregnant Women ◽

Liver Dysfunction ◽

Hellp Syndrome ◽

Liver Diseases ◽

Hyperemesis Gravidarum ◽

Late Pregnancy ◽

Risk Groups ◽

Acute Fatty Liver

Liver disease associated with pregnancy affects up to 3% of women and is a common cause of dysfunction during pregnancy. Severe liver dysfunction is associated with high rates of maternal and infant morbidity and mortality.Therefore, it is important to know about liver diseases the woman suffered before pregnancy in order to adequately manage the pregnancy and reduce the number of complications during delivery. Research and recent advances in medicine tend to improve the consequences, but so far they have not shown significant reduction of the maternal and perinatal morbidity rates against the background of this pathology. Liver diseases that are characteristic for pregnancy can be classified into those of early pregnancy (hyperemesis gravidarum) and those of late pregnancy (preeclampsia/eclampsia, intrahepatic cholestasis of pregnant women; hemolysis, increased activity of liver enzymes) HELLP-syndrome, acute fatty liver disease of pregnant women - AFLP, liver rupture / infarction).The results of modern studies used in the practice of medical care for pregnant women with concomitant pathology have significantly improved the pregnancy and delivery outcomes, but the number of complications among the mother and the fetus is still high. In this article, we offer an overview of liver diseases complicated by pregnancy with a detailed presentation of their aetiology, pathogenesis, diagnosis, and treatment. The risk groups of pregnant women with the potential possibility of liver dysfunction development have also been identified.

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ACUTE FATTY LIVER OF PREGNANCY MASQUERADING AS HELLP SYNDROME

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2018/335 ◽

2018 ◽

Vol 5 (20) ◽

pp. 1592-1595

Author(s):

Santhosh Narayanan ◽

Divya Prakash ◽

Gomathy Subramaniam ◽

Lakshminarayanan Lakshminarayanan

Keyword(s):

Fatty Liver ◽

Hellp Syndrome ◽

Acute Fatty Liver

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Comparison of Maternal and Neonatal Outcomes between Acute Fatty Liver of Pregnancy and Hemolysis, Elevated Liver Enzymes and Low Platelets Syndrome: A Retrospective Cohort Study

10.21203/rs.3.rs-111120/v1 ◽

2020 ◽

Author(s):

Sau Xiong Ang ◽

Chie-Pein Chen ◽

Fang-Ju Sun ◽

Chen-Yu Chen

Keyword(s):

Cohort Study ◽

Fatty Liver ◽

Retrospective Cohort Study ◽

Hellp Syndrome ◽

Retrospective Cohort ◽

Liver Enzymes ◽

Neonatal Outcomes ◽

Elevated Liver Enzymes ◽

Acute Fatty Liver ◽

Maternal And Neonatal Outcomes

Abstract Background: Acute fatty liver of pregnancy (AFLP) and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome are two uncommon disorders that mimic each other clinically, but are distinct pathophysiologically. This study aimed to compare maternal and neonatal outcomes between AFLP and HELLP syndrome.Methods: This retrospective cohort study was performed at a tertiary referral center in Taiwan between June 2004 and April 2020. We used the Swansea Criteria to diagnose AFLP, and the Tennessee Classification System to diagnose HELLP syndrome. Maternal characteristics, laboratory data, complications, and neonatal outcomes were analyzed.Results: During the study period, 21 women had AFLP and 80 women had HELLP syndrome. There was a higher rate of preeclampsia (95.0% versus 23.8%) in the HELLP syndrome group compared to the AFLP group. However, the AFLP group had more other maternal complications including jaundice (85.7% versus 13.8%), acute kidney injury (61.9% versus 15.0%), disseminated intravascular coagulopathy (66.7% versus 8.8%), and sepsis (47.6% versus 10.0%) compared to the HELLP syndrome group. Nevertheless, higher rates of small for gestational age neonates (57.1% versus 33.3%), neonatal respiratory distress syndrome (39.2% versus 8.3%) and neonatal sepsis (34.2% versus 12.5%) were noted in the HELLP syndrome group.Conclusions: AFLP is associated with a higher rate of multiple organ dysfunction in mothers, whereas HELLP syndrome is associated with a higher rate of neonatal morbidity.

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Oxidative Stress, Neutrophil Elastase and Vascular Endothelial Growth Factor in Obese Pregnant Women with Preeclampsia

Biomedical & Pharmacology Journal ◽

10.13005/bpj/1819 ◽

2019 ◽

Vol 12 (04) ◽

pp. 1887-1891

Author(s):

Moushira Zakia ◽

Taghreed Shalabi ◽

Tamer Hussein ◽

Mohamed Hammam ◽

Eman Youness ◽

...

Keyword(s):

Oxidative Stress ◽

Risk Factors ◽

Blood Pressure ◽

Growth Factor ◽

Pregnant Women ◽

Neutrophil Elastase ◽

Inflammatory Marker ◽

Vascular Endothelial ◽

Obese Women ◽

Endothelial Growth Factor

Oxidative stress, inflammation, and vascular endothelial proliferation and obesity are risk factors associated with preeclampsia (PE). Thepresent study aimed to investigate the levels of malondialdehyde (MDA) as a putative circulatory marker of oxidative stress, neutrophil Elastase (NE) as inflammatory marker andvascular endothelial growth factor (VEGF) as marker for vascular permeability-enhancing activities inobese women withpreeclampsia PE and compare withnormal pregnancy women. The study was carried out on 50 pregnant obese women with PE and 50 normal pregnant women. The preeclampsia women were characterized with high blood pressure 160/110 mmHg and proteinuria. The gestational age ranged from ≥32 weeks to <37 weeks. Pre pregnancyweightwas recorded. Body mass index (BMI) was calculatedat delivery.SerumMDA, NEand VEGF were estimatedby ELISA. Significant higher levels of serum MAD,NE and VEGF were observed in obese PE patients as compared to normal controls. Our results suggested thatobesity;oxidative stress, NEandVEGFbiomarkers are risk factors for PE,emphasizing their role as feasible candidate risk markersfor cases withhigh blood pressure in early pregnancy.

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Markedly higher sFlt-1/PlGF ratio in a woman with acute fatty liver of pregnancy compared with HELLP syndrome

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.13786 ◽

2018 ◽

Vol 45 (1) ◽

pp. 96-103 ◽

Cited By ~ 4

Author(s):

Hirotada Suzuki ◽

Shiho Nagayama ◽

Chikako Hirashima ◽

Kayo Takahashi ◽

Hironori Takahashi ◽

...

Keyword(s):

Fatty Liver ◽

Hellp Syndrome ◽

Acute Fatty Liver ◽

Plgf Ratio

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863: Pragmatic laboratory studies to differentiate acute fatty liver of pregnancy and HELLP syndrome on admission

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.11.886 ◽

2019 ◽

Vol 220 (1) ◽

pp. S561 ◽

Cited By ~ 1

Author(s):

John J. Byrne ◽

Angela Seasely ◽

Donald McIntire ◽

David B. Nelson ◽

F. Gary Cunningham

Keyword(s):

Fatty Liver ◽

Hellp Syndrome ◽

Laboratory Studies ◽

Acute Fatty Liver

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Maternal and perinatal outcomes of hypertensive disorders of pregnancy in Ethiopia: systematic review and meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2617-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Amanual Getnet Mersha ◽

Tadesse Melaku Abegaz ◽

Mohammed Assen Seid

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Maternal Death ◽

Hellp Syndrome ◽

Perinatal Death ◽

Hypertensive Disorder ◽

Hypertensive Disorders Of Pregnancy ◽

Hypertensive Disorders ◽

Pooled Prevalence

Abstract Background Hypertensive disorders of pregnancy complicate around 6% of pregnancies and accounts for 19% of maternal death in Ethiopia. The current review aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Ethiopia. Methods A systematic review and meta-analysis was done on the outcome of hypertensive disorder among pregnant women in Ethiopia. Literature search was made in five databases and Statistical analyses were carried out by using Stata 14 software. The pooled prevalence of maternal death, HELLP syndrome, perinatal death, and low birth weight was calculated using a random-effects model. Egger’s test and funnel plot were used to evaluate publication bias. The Cochran Q test and I2 test statistics were used to test the heterogeneity of studies. Result Thirteen studies included in the review, with an overall sample size of 5894 women diagnosed to have hypertensive disorder of pregnancy. The pooled prevalence of maternal death was estimated to be 4% (95% CI: 2, 6%). The pooled prevalence of HELLP syndrome was 13% (95% CI: 10, 16%). Other complications such as pulmonary edema, kidney injury, hepatic injury, placental abruption, and aspiration pneumonia were also reported. Perinatal death was observed in one-fourth of women with HDP 25% (95% CI: 18, 32%). The pooled prevalence of low birth weight neonate in a woman with HDP is 37% (95% CI, 27, 48%). Conclusions In Ethiopia, the prevalence of perinatal and maternal mortality among pregnant women with one of the hypertensive disorders were found to be higher than rates reported from high income as well as most of the low and middle income countries. For instance, one in four of pregnancies complicated by hypertensive disorder end up in perinatal death in Ethiopia. HELLP syndrome, placental abruption, pulmonary edema, renal damage, prematurity, perinatal asphyxia, and low birth weight were also commonly reported. To improve the health outcomes of hypertensive disorders of pregnancy, it is recommended to improve utilization of maternal health service; early detection and early referral of pregnant women with hypertensive disorder; advocating policies and strategies that improves the quality of health care that a pregnant woman and her newborn receive.

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