132 Evaluation of the fullpiererse maternal and fetal outcomes in women with hypertensive disorders of pregnancy

Abstract

Introduction The fullPIERS model is an instrument of simple evaluation and low-cost that uses clinical variables to stratify pregnant women with preeclampsia at high risk for adverse outcomes. However, differentiating high-risk patients amongst the variety presentations of hypertension disorders of pregnancy (HDP), not only preeclampsia, represents a daily challenge for obstetricians. Objectives The aim of this study is to evaluate the use of the fullPIERS model as a predictor of maternal and fetal adverse outcomes in women with hypertensive disorders of pregnancy. Methods This is a prospective cohort ongoing at the obstetric unit of a teaching hospital in Porto Alegre, Brazil. Pregnant women, after 20 weeks of gestation, admitted to the hospital with systolic blood pressure ⩾ 140 and/or diastolic blood pressure ⩾ 90 mmHg were enrolled. Women in active labor at the moment of hospital admission were excluded. The worst clinical and laboratory data from the first 48 hours after admission were recorded. Development of maternal and perinatal outcomes was observed for 14 days. Classification into HDP categories (gestational hypertension, preeclampsia, chronic hypertension and chronic hypertension with superimposed preeclampsia) was completed after delivery. Results • Until this moment, seventy-nine women were included to the study. Thirteen (16.5%) with gestational hypertension, 44 (55.5%) with preeclampsia, 11 (14%) with superimposed preeclampsia and 11 (14%) with chronic hypertension. • Thirty three (42%) women had at least one adverse outcome. Elevated liver enzymes was the most common adverse outcome, occurring in 28 (35%) women. • The group with gestational hypertension had a significant lower incidence of adverse maternal outcomes (2 cases, 15%) when compared to preeclampsia (20 cases, 45.5%) (p 0.05) and superimposed preeclampsia patients (6 cases, 54.5%) (p 0.05). There were no differences comparing development of adverse outcomes between preeclampsia and superimposed preeclampsia groups, or comparing the chronic hypertensive group (5 cases, 45.5%) with any of the other groups. • Twelve (15%) newborns were admitted to intensive care unit and four (5%) neonatal deaths occurred. Women with preeclampsia and superimposed preeclampsia had more perinatal adverse outcomes when compared to other groups (p 0.009). • The fullPIERS model did not demonstrate association with the development of maternal adverse outcomes during the 14 days of follow-up. On the other hand, fullPIERS model predicted adverse fetal outcomes within 14 day of eligibility (AUC ROC 0.73, 95% CI 0.56-0.89). The classification accuracy of fullPIERS was fair. Using a predicted probability of 0.16 as a threshold, fullPIERS obtained a specificity of 80% and a negative predictive value of 90%, whereas correctly classified 54% of women who subsequently had events as being at high risk. Conclusions In our study, fullPIERS model could not predict maternal adverse outcomes within 14 days of hospital admission in women with different categories of HDP. However, we demonstrated that fullPIERS had a reasonable discrimination predicting fetal adverse outcomes in the same period. The main limitation of this study is the small sample size, especially in view of the broad spectrum of pregnant women with elevated blood pressure included. Nonetheless, the elevated rate of adverse outcomes in our sample corroborates to the need for studies that can be generalized to the women with HDP presenting with different features at obstetric units.