Risk factors of adverse pregnancy outcomes during expectant management of early onset severe pre-eclampsia

Abstract

To identify the risk factors of adverse pregnancy outcomes in expectant management of pregnant women with early onset severe pre-eclampsia (EOSP). Totally, 136 gravidas, who were diagnosed as ESOP and received expectant management from January 2007 to June 2008 in Beijing Obstetrics and Gynecology Hospital, were selected and divided into two groups: the favorable pregnancy outcome group (control, n = 101) and the adverse pregnancy outcome group (n = 35). The general clinical information, pregnancy outcomes, routine urine test, hemodynamic data, routine blood test, liver and renal function test on admission were collected and the risk factors for adverse outcomes were retrospectively analyzed. (1) General clinical information: more women complained of preeclamptic symptoms on admission in the adverse outcome group than in the control group (35.6% vs. 57.1%, P < 0.05). No significant differences was found between the two groups in the maternal age, times of previous pregnancies, prevalence of concurrent complications, pre-pregnant body mass index (BMI), proportion of women who had regular antenatal checks (P > 0.05). (2) Pregnant outcomes: the average duration of expectant management in the control group were similar to the adverse outcomes group [(6.5 +/- 8.2) days vs. (6.8 +/- 10.0) days, P > 0.05]. The main complications in the adverse outcome group included placental abruption (n = 13), heart failure and pulmonary edema (n = 10), hemolysis, elevated liver enzymes and low platelet syndrome (HELLP syndrome, n = 5), and no eclampsia was reported. However, none of these complications was reported from the control group. (3) Blood pressure and proteinuria: the gestation ages at the onset of EOSP and at delivery in the control group were earlier than those of the adverse outcome group [(31.3 +/- 3.4) weeks vs. (33.0 +/- 4.9) weeks, (32.1 +/- 3.0) weeks vs. (34.0 +/- 3.6) weeks, P < 0.05], the systolic blood pressure and urinary protein and the proportion of women with urinary protein of (+++) were also much higher in the adverse outcome group (all P < 0.05). (4) Hemodynamics and routine blood tests: the blood viscosity in the control group was obviously lower than that of the adverse outcome group (P < 0.05). But there was no significant difference in the cardiac output, cardiac index, peripheral resistance and vascular compliance between the two groups (P > 0.05). The adverse outcome group showed lower platelet (PLT) level and higher red blood cell (RBC) count and hematocrit compared with those of the control (all P < 0.01). (5) Liver and renal function: the alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), blood urea nitrogen (BUN) in the adverse outcome group were significantly higher than those of the control group (all P < 0.05), but the plasma level of total protein (TP), albumin (Alb), uric acid (UA) and creatinine (Cr) were similar between the two groups (P > 0.05). (6) Risk factor analysis: RBC count (OR = 3.68, 95%CI: 1.90-7.13), PLT count (OR = 0.99, 95%CI: 0.98-1.00) and the gestations at delivery (OR = 0.87, 95%CI: 0.80-0.94) were the risk factors of adverse pregnancy outcomes during the expectant management of EOSP. Elevated RBC count, reduced PLT count and earlier delivery weeks are the risk factors of adverse pregnancy outcomes during the expectant management of EOSP.