Clinical characteristics and timing of delivery in women with severe preeclampsia complicated with ascites

Abstract

Objective To investigate the clinical characteristics and the optimal time of delivery in pregnant women with severe preeclampsia complicated with ascites. Methods A retrospective study was conducted on 179 severe preeclampsia mothers and their 195 neonates, presented in the First Affiliated Hospital of Wenzhou Medical College from Jan. 2003 to Dec. 2005, who were divided into two groups： 32 complicated with ascites （aseites group） and 147 without （non-ascites group）. The general conditions, mode of delivery and complications including eclampsia, hemolysis, elevated serum level of liver enzymes, and low platelets （HELLP syndrome）, liver failure, renal failure, heart failure, hypoproteinemia, placental abruption, postpartum hemorrhage and puerperal infection, were also analyzed. Clinical data of all infants （38 from aseites group and 157 from non-aseites group） were analyzed. The incidence and mortality rate of small for gestational age （SGA） in both group within the same gestational age group and those between different gestational age groups in the ascites group were compared. Results （1） The average gestations at admission and delivery in the ascites group were earlier than the other [admission： （32.5±2.1）weeks vs （36.1±3.5）weeks; delivery： （34.1±2.3） weeks vs （37.2±1.5）weeks, P〈0.05]. The rate of systemic antenatal care in the ascites group was lower than that of the non-ascites group （25.0% vs 53.7%, P〈0. 05）. More complications were found in the ascites group than in the non-ascites group （hypoproteinemia： 100.0%vs 47.0% ;liver and renal failure： 31.2% vs 8.2%; HELLP syndrome： 9.4% vs 2.0%; postpartum hemorrhage： 18.8% vs 2.0% ; all P〈0.05）. （2） The incidence of SGA in the ascites group was all higher than that in the non-ascites group, however, significant differences was only found between the two groups at 〉36 weeks （7/9 vs 30.2%, P〈0.05）. The perinatal mortality rates of SGA in the ascites group at 〈32 weeks and 32-34 weeks were significantly higher than that in the non-ascites group respectively （〈32 weeks： 69.2% vs 19.2%, P〈0.05; 32-34 weeks： 2/7 vs 0, P〈0.05）. （3） The highest perinatal mortality rate and the highest incidence of SGA in the ascites group were found in the groups of 〈32 weeks and 〉36 weeks, respectively. Conclusions The early onset of ascites and higher rate of complications in severe preeclamptic women implies the adverse maternal and fetal outcomes. Ascites in severe preeclampsia cases should alert the clinicians. The optimal time for delivery might be at 32-36 weeks of gestations. Key words: Pre-eclampsia; Ascites; Retrospective studies