High-risk Pregnancy Care Research Articles

Experience with home-based, remote non-stress tests, including automatic decision support for interpretation of reactivity

The fetal non-stress test (NST) for antepartum surveillance involves frequent, burdensome in-office visits. INVUTM is a wireless, remote, FDA-cleared monitoring device, designed to perform self-administered NST from home. Here, we present (1) our initial experience with INVUTM home NST monitoring, and (2) a novel machine learning decision support system (DSS) to detect fetal heart rate (FHR) accelerations, with the potential to alert clinicians on NST reactivity. A single-center, prospective, open label study was conducted, in which women with ≥32 week high-risk singleton gestations performed self-administered NST using the INVUTM device at home, replacing in-clinic NSTs. NSTs were reviewed by clinicians via the INVUTM web application who determined clinically interpretability and reactivity. Interpretable sessions were retrospectively analyzed by the DSS for reactivity and compared to clinician assessment (Figure). The time to reactivity as analyzed by the DSS was compared to the session length until reactivity was determined by clinicians. Of the first 30 INVUTM sessions (across 9 subjects), clinicians deemed 27 (90%) interpretable, and 27/27 as reactive (100%). The DSS correctly classified 92.6% (25/27) of the interpretable NSTs compared with clinicians. In the 2 cases where DSS did not match the clinician decision, DSS did not rule the NST reactive, whereas the clinician did. On review, these cases may have been due to clinician averaging the FHR baseline from which accelerations are measured, compared to the conservative nature of the DSS. In the cases deemed reactive by DSS, time to reactivity was reduced by 14.72±13.79 min as compared to clinician determination. Early clinical experience conducting self-administered, remote NSTs at home using the INVUTM device supports the feasibility of bringing this telehealth solution to high risk pregnancy care. In addition, a novel DSS tool accurately identifies reactivity, which could reduce the length of NST sessions and improve clinician workflow.

PlGF (Placental Growth Factor) Testing in Clinical Practice: Evidence From a Canadian Tertiary Maternity Referral Center.

[Figure: see text].

401 Amplitude-modulation of maternal electrocardiography and phonocardiography as a novel method for wireless non-invasive uterine monitoring

Uterine activity (UA) monitoring is an essential element of pregnancy management. The gold standard intrauterine pressure catheter (IUPC), is invasive and requires ruptured membranes. Conventional, external tocodynamometry (TOCO) is hampered by obesity, maternal movements, and belt positioning, with positive agreement rates (PA) as low as 54-73% and false detection rates (FDR) as high as 15-32%. We prospectively tested a novel algorithm that enables non-invasive and reliable detection of UA. A prospective, comparative, open label, multicenter study was conducted, in which 40 laboring women (≥32 weeks; BMI<50) were simultaneously monitored for 30-60 minutes with IUPC and INVU (Nuvo Group), a wireless device FDA-cleared for remote fetal and maternal heart rate monitoring. Ten subjects were monitored with TOCO as well. UA detection by INVU was based on the modulation of the maternal electrocardiographic and phonocardiographic signals. 3 blinded assessors marked the contractions for each modality. PA and FDR of INVU and TOCO compared to IUPC were calculated. Overall, INVU correctly identified 87.7% of the IUPC contractions. Sub-analysis based on BMI categories (normal: <25, overweight: 25-30, obese: ≥30) showed that UA detection was not affected by BMI (PA: 88.5%, 85.9% and 90.0%, respectively; p=0.42). Overall, INVU FDR was 15.2%. In the subset of sessions recorded with TOCO, TOCO PA and FDR were 46% and 7.1% respectively. UA monitoring via INVU is accurate and reliable, even in obese women, and more precise than TOCO. There is a pressing need for telehealth solutions in pregnancy monitoring, underscored by the current COVID-19 pandemic. INVU (Nuvo Group) is a self-administered device, FDA-cleared for wireless, remote monitoring of fetal and maternal heart rate. This novel method for UA detection via INVU expands its remote pregnancy monitoring capabilities to include surveillance such as non-stress tests, which would be of great benefit to women and providers seeking telehealth solutions for high risk pregnancy care.

A Current View of Care of High Risk Pregnancy

A Current View of Care of High Risk Pregnancy

Family Support Related to Information, Comfort, Economy and Spiritual in Preeclamptic Pregnancy Care: Qualitative Exploration

Introduction: Preeclampsia is emergencies in obstetrics, where pregnant women experience health conditions that can be life-threatening and can occur during pregnancy, natal and post-natal. If this obstetric emergency is not treated immediately, it can result in death the mother and also the fetus. Understanding care needs of pregnant with preeclampsia is very important for families because most pregnant women and their families lack understanding and information about high-risk pregnancy care for this disease. Objectives: This research aims to explore the needs of families in the care of preeclampsia. Methods: This research used qualitative descriptive to obtain answers related to individual opinions, responses and perceptions with exploring family needs for care pregnant with preeclampsia. Results: The results of this research there are seven themes related to family needs in pregnancy care with preeclampsia, namely: 1) Description of family knowledge about pregnant with preeclampsia, 2) Information needs, 3) Comfort needs, 4) Economic / financial needs, 5) Spiritual needs, 6) Needs for support from other family members, 7) Need for support from health workers. Conclusions: The importance of involvement of the family and surrounding environment, as a source of strength for pregnant with preeclampsia allows better care for mothers, their babies and reduces the consequences of advanced preeclampsia. Health workers are expected to be able to involve families in the care of pregnant women with preeclampsia as a promotional, preventive and curative effort. 1) Description of family knowledge about pregnant with preeclampsia, 2) Information needs, 3) Comfort needs, 4) Economic / financial needs, 5) Spiritual needs, 6) Needs for support from other family members, 7) Need for support from health workers. Conclusions: The importance of involvement of the family and surrounding environment, as a source of strength for pregnant with preeclampsia allows better care for mothers, their babies and reduces the consequences of advanced preeclampsia. Health workers are expected to be able to involve families in the care of pregnant women with preeclampsia as a promotional, preventive and curative effort. 1) Description of family knowledge about pregnant with preeclampsia, 2) Information needs, 3) Comfort needs, 4) Economic / financial needs, 5) Spiritual needs, 6) Needs for support from other family members, 7) Need for support from health workers. Conclusions: The importance of involvement of the family and surrounding environment, as a source of strength for pregnant with preeclampsia allows better care for mothers, their babies and reduces the consequences of advanced preeclampsia. Health workers are expected to be able to involve families in the care of pregnant women with preeclampsia as a promotional, preventive and curative effort.

Society for Maternal-Fetal Medicine Special Statement: Society for Maternal-Fetal Medicine’s conflict of interest policy

A vital mission of the Society for Maternal-Fetal Medicine is to provide independent, objective, scientifically based information and recommendations for providers, patients, and payors of high-risk pregnancy care. To ensure that these recommendations are free from bias, special interest, or the perception of either, a publicly transparent process for disclosing relevant financial and nonfinancial interests (disclosures of interest) and management of potential conflicts of interest are essential. Educational and research presentations also require proper disclosure to allow attendees to properly assess information presented at the Society for Maternal-Fetal Medicine events. The Society for Maternal-Fetal Medicine established a task force to review the current Society for Maternal-Fetal Medicine policies and procedures as they pertain to disclosure of interest and conflict of interest. To establish current best practices in disclosure of interest and conflict of interest definitions, reporting, and conflict of interest mitigation, members of the task force reviewed external literature, including policies of other medical organizations. The Society for Maternal-Fetal Medicine is committed to a continuous process of improvement in the approach to these issues and will revise this policy as indicated.

Patient Perceived Value of Referral to Maternal and Fetal Medicine Subspecialists [25M

INTRODUCTION: Maternal and fetal morbidity and mortality is a national and public health concern. One of the most critical factors to quality maternal fetal care for high-risk pregnancies is access to specialty tertiary care. Our center serves 25. This study assessed patient satisfaction of high-risk pregnancies referred for consultation to the High-Risk Pregnancy Services at a tertiary care center in the US. METHODS: Prospective pre and post surveys were administered to pregnant women referred to the High-Risk antenatal clinics. This study was IRB approved. All patients consented to participate in this study. RESULTS: 50 women completed the pre-visit and post-visit surveys. The average GA at referral was 21 3/7 weeks. The wait time for scheduled appointment from the initial referral was 2.5 weeks. Patients traveled 57.5 ± 32.3 minutes. 45% of the patients reported not understanding the reason for referral. 60% expressed a desire to see a physician after completion of their ultrasound. On post-visit survey, patient’s perceived anxiety was significantly reduced (P=.007). In 16% the ultrasound findings were different from the local findings. 88% of patients indicated a better understanding of pregnancy issues as well as management of their pregnancy. 67.5% rated their overall satisfaction as excellent, 25% as good and 1% as fair. CONCLUSION: Not all referred women fully understand the role of a maternal fetal specialist, nonetheless, following the referral appointment and consultation, majority expressed better understanding and felt reassured regarding their pregnancy care. This survey indicates a need for and easy availability of maternal fetal expertise to all pregnant women.

English

This study seeks to clarify the current situation and associated factors regarding Work Engagement (WE) among midwives working in advanced care facilities, which bear the brunt of care for high-risk pregnancies, as well as the contribution of WE to quality of care. A self-administered questionnaire survey was conducted in 2016 with the participation of 503 midwives working in 36 general perinatal maternal and child medical centers and with 125 nurses working at a university hospital selected for analysis as a comparison group. The survey used the Utrecht Work Engagement Scale and the Brief Job Stress Questionnaire, subjecting all results to multiple regression analysis to adjust the sample size. Results revealed that WE among midwives was not found to be significantly different from that among nurses. WE among midwives was found to be positively associated with the “presence of a role model” and “doctor support”. In addition, WE as well as “career opportunities” and the “presence of a role model” were associated with quality of care (adjusted R2 =0.137, P < 0.05). From the study, WE among midwives working at advanced perinatal care facilities was not found to be different from that among nurses working at university hospitals. Among factors contributing to higher WE, the presence of a role model and relationships of trust with physicians were found to be those that represented the occupational characteristics of midwifery. Key words: Midwife, work engagement, job stress, role model, quality of care.

Challenge in the Management of Twin Pregnancy with Anencephaly of One Fetus in a Low- Income Country: A Case Presentation

Anencephaly of one twin is a frequent congenital abnormality in a twin pregnancy and it’s associated with a poor prognosis of this pregnancy. In developed countries, the goal standard management calls for an interventional fetal medicine either by injection of a cardiotoxic or by intervention on the umbilical cord. Another option is an expectative management with strict follow-up of pregnant women and delivery organized in a level 3 maternity. There is still a challenge in the management of such high risk pregnancy in low income countries. A 37 years-old female, G3P2002, referred from a clinic for the better management of a 28 weeks and 4 days twin pregnancy in labor. Obstetrical ultrasonography realized in the second trimester revealed dichorionic-diamniotic pregnancy and the presence of anencephaly with hydramnios of one twin. The expectative approach was adopted for the management of this high risk pregnancy, unfortunately the death of the fetus occurred despite all the care provided. This case brings to lamp light the difficulties encountered in providing standard obstetrical care for high risk pregnancies in resource limited settings.

749: Impact of distance traveled to prenatal care on outcomes of pregnancies complicated by pregestational diabetes

The concentration of high-risk pregnancy care in urban centers and rural hospital closures have caused concern about the distances patients travel for care and its impact on outcomes. We aimed to assess the impact of distance traveled to site of prenatal care (PNC) on perinatal outcomes in women with pregestational diabetes (DM). Retrospective cohort of all women with DM delivering at a single academic center from 2007-2013. Women were excluded for major medical problems (not hypertension), fetal anomalies, and entry to PNC ≥26 weeks. Exposure was classified into residing <30 miles, 30-60 miles, and >60 miles from the site of PNC. The primary maternal outcome was cesarean delivery (CD). Secondary maternal outcomes were primary CD, markers of glycemic control, and preeclampsia. The primary neonatal outcome was macrosomia (>4000g) and secondary neonatal outcomes were shoulder dystocia, neonatal hypoglycemia (<40 mg/dL), and hyperbilirubinemia. Chi square, Fisher exact, and ANOVA were used as appropriate. A multivariable logistic regression model was performed controlling for important confounding variables using <30 miles as the referent group. Impact of distance from the hospital was also evaluated as a continuous variable. Of 475 women, 341 (71.8%) lived <30 miles, 72 (15.2%) 30-60 miles, and 62 (13.1%) >60 miles from the site of PNC. Women living closest to the site of PNC were more likely to be black and less likely to use diabetic medications prior to or use insulin during pregnancy. Odds of CD and primary CD increased with distance from the hospital (Table). For each 1 mile over 30 miles lived from the site of PNC, the odds of primary CD increased by 1% (95% CI 1.003-1.030). Glycemic control, macrosomia, shoulder dystocia and hyperbilirubinemia did not differ between groups. Odds of neonatal hypoglycemia doubled with increased distance from PNC (Table). Per mile over 30 miles, the odds increased 1% (95% CI 1.004-1.021). Traveling further for prenatal care was associated with increased odds of cesarean and neonatal hypoglycemia, in spite of no detectable differences in glycemic control. When access to care and maternal morbidity are explored, distance from site of care should be considered as a contributing factor to patient and public health outcomes.

Reinforcing the Connections: Translating Research Findings Into Practice to Improve Continuity of Care in High Risk Pregnancies

Reinforcing the Connections: Translating Research Findings Into Practice to Improve Continuity of Care in High Risk Pregnancies

Nature-Inspired Algorithm for Training Multilayer Perceptron Networks in e-health Environments for High-Risk Pregnancy Care.

Nature presents an infinite source of inspiration for computational models and paradigms, in particular for researchers associated with the area known as natural computing. The simultaneous optimization of the architectures and weights of artificial neural networks (ANNs) through biologically inspired algorithms is an interesting approach for obtaining efficient networks with relatively good generalization capabilities. This methodology constitutes a concordance between a low structural complexity model and low training error rates. Currently, complexity and high error rates are the leading issues faced in the development of clinical decision support systems (CDSSs) for pregnancy care. Hence, in this paper the use of a biologically inspired technique, known as particle swarm optimization (PSO), is proposed for reducing the computational cost of the ANN-based method referred to as the multilayer perceptron (MLP), without reducing its precision rate. The results show that the PSO algorithm is able to improve computational model performance, showing lower validation error rates than the conventional approach. This technique can select the best parameters and provide an efficient solution for training the MLP algorithm. The proposed nature-inspired algorithm and its parameter adjustment method improve the performance and precision of CDSSs. This technique can be applied in electronic health (e-health) systems as a useful tool for handling uncertainty in the decision-making process related to high-risk pregnancy. The proposed method outperformed, on average, other approaches by 26.4% in terms of precision and 14.9% in terms of the true positive ratio (TPR), and showed a reduction of 35.4% in the false positive ratio (FPR). Furthermore, this method was superior to the MLP algorithm in terms of precision and area under the receiver operating characteristic curve by 2.3 and 10.2%, respectively, when applied to the delivery outcome for pregnant women.

The Change of Perinatal Mortality Over Three Decades in a Reference Centre in the Aegean Region: Neonatal Mortality has decreased but Foetal Mortality Remains Unchanged.

Background:Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area.Aims:Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population.Study Design:Cross-sectional retrospective study.Methods:The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point) and 1988-1989 (2nd time point) were compared with the year 2008 (3rd time point). The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated.Results:Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades.Conclusion:Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for high risk pregnancies are needed.

Psychosocial Adaptation and Depressive Manifestations in High-Risk Pregnant Women: Implications for Clinical Practice.

High-risk pregnancy research has focused primarily on psychological well-being. The aim is to determine psychosocial adaptation and depression levels of pregnant women who were admitted to hospital with diagnosis of high-risk pregnancy. This study was descriptive. Sampling was composed of 122 high-risk pregnant women who were hospitalized in the perinatology service of Istanbul University Medical School, Department of Obstetrics and Gynecology between January 1, 2014, and May 31, 2014, and met the study criteria. The Pregnant Introduction Form, Psychosocial Adjustment of Illness Scale-Self Report, and CES Depression Scale were used. Of high-risk pregnant women, 47% were found to have a poor level of psychosocial adaptation and 57% presented with depressive symptoms. There were statistically significant difference found between the levels of psychosocial adaptation and status of depressive manifestations. The difference between the average scores increased as the adaptation levels weaken and the pregnant women with a poor level of psychosocial adaptation showed more depressive manifestations. The results of this study indicate that, depending on the high-risk pregnancy status, pregnant women experience difficulty in adaptation to their current status and pregnant women with a poor level of psychosocial adaptation showed more depressive manifestations. Nurses should deliver care in high-risk pregnancies with the awareness of physiological needs as well the psychosocial needs of pregnant women, and information meetings should be held in order to increase the psychosocial support of their families and decrease their tendency toward depression. Nursing initiatives should be developed with further studies for the psychosocial adaptation of high-risk pregnancy and reduction of the depressive manifestations.

Translation and cross-cultural adaptation of "Hoja Verde de Salud Medioambiental Reproductiva" in Brazil

Abstract Objectives: to perform a cross-cultural adaptation of "Hoja Verde de Salud Medioambiental Reproductiva", originally conceived in Spanish for Brazilian Portuguese. Methods: the translation and cross-cultural adaptation process was carried out in five stages: translation, synthesis of the versions, back-translation, the acquisition of a consensual version after reviewed by the committee specialists and the application of the pretest to obtain the final version. The interviews were carried out at two reference services in maternal and child health, both located in Recife, Pernambuco, which provided medical care for high-risk pregnancies with a diversified clientele regarding the region of the State. Results: there were difficulties in understanding some words during the pretest and the precision of dates for medication use, radiation tests, as well as weeks of pregnancy and breastfeeding duration in weeks. The committee specialists made some alterations on the questionnaire considering suggestions made by the interviewees. Conclusions: after the adaption process, an available instrument in detecting environmental risks which might be incorporated in the maternal and child health routines and could contribute in detecting and preventing diseases and the severities and promote health for Brazilian children.

Compendium for the antenatal care of high‐risk pregnancies

The Obstetrician & GynaecologistVolume 18, Issue 2 p. 161-161 Book Review Compendium for the antenatal care of high-risk pregnancies First published: 07 April 2016 https://doi.org/10.1111/tog.12289Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume18, Issue2April 2016Pages 161-161 RelatedInformation

Comprehensive Care of High-risk Pregnancy for Reducing Maternal Mortality - A Proposal to Establish a Korean Pregnancy and Birth Registry –

This study aims at modeling boundary layers (BLs) encountered in sparse and built environments (i.e., open, suburban and urban) at the subsonic Wind Tunnel (WT) at Ryerson University (RU). This WT has an insignificant turbulence intensity and requires a flow-conditioning system consisting of turbulence generating elements (i.e spires, roughness blocks, barriers) to achieve proper turbulent characteristics. This system was developed and validated in the current study in three phases. In phase I, several Computational Fluid Dynamic (CFD) simulations of the tunnel with generating elements were conducted to understand the effect of each element on the flow. This led to a preliminary design of the system, in which horizontal barriers (slats) are added to the spires to introduce turbulence at higher levels of the tunnel. This design was revisited in phase II, to specify slat dimensions leading to target BLs encountered by tall buildings. It was found that rougher BLs require deeper slats and, therefore, two-layer slats (one fixed and one movable) were implemented to provide the required range of slat depth to model most BLs. This system only involves slat movement to change the BL, which is very useful for automatic wind tunnel testing of tall buildings. The system was validated in phase III by conducting experimental wind tunnel testingof the system and comparing the resulting flow field with the target BL fields considering two length scales typically used for wind tunnel testing. A very good match was obtained for all wind field characteristics which confirms accuracy of the system.

Maternal Outcome of Hypothyroidism in Pregnancy- a South Indian Perspect

<b>Background</b><b>:</b><b> </b>Hypothyroidism in pregnancy is increasing and is a major cause for concern because of its association with adverse maternal outcome if untreated. The literature related to the burden of adverse pregnancy outcomes associated with hypothyroid pregnant women on thyroxine replacement therapy is limited. Hence, this study was designed. <b>Objective</b><b>:</b><b> </b>The primary objective was to study the maternal outcome of hypothyroidism in pregnancy<b>.</b><b> </b><b>Methodology</b><b>:</b><b> </b>This study was conducted in the Department of Obstetrics & Gynecology in Govt. Medical College Trivandrum. This was a mixed method study that included retrospective patient data collection and a prospective matched case control study. Seventy-eight pregnant women were recruited as cases based on diagnosis of hypothyroidism prior to pregnancy from the medical department records. They were compared with 78 euthyroid pregnant women, approximately age matched. History and pregnancy outcome were assessed. Data was analyzed using SPSS statistical package. <b>Results</b><b>:</b><b> </b>Hypothyroidism was associated with 3.6 times higher risk of developing threatened abortion and 3.8 times higher risk of developing gestational hypertension (P=0.001). Rate of caesarian section (51.3%) and postpartum hemorrhage (12.8%) were higher among cases. <b>Conclusions</b><b>:</b><b> </b>Based on our study we conclude that hypothyroid mothers, in spite of thyroid replacement therapy, are at significantly higher risk of obstetric complications. A multidisciplinary team approach, where the services of an endocrinologist and an obstetrician experienced in high risk pregnancy care are used, and a tertiary level institution with good facilities for ante partum and intrapartum care, is essential to improve the outcomes.

Indications of 1342 Fetal Cord Blood Sampling Procedures Performed as an Integral Part of High Risk Pregnancy Care

Fetal umbilical cord blood sampling is now being performed worldwide, using an ultrasound guided technique, for prenatal diagnosis in pregnancies at high risk for several congenital and genetic defects in the fetus. Awareness of feasibility of the procedure and indications for the same should be known to every obstetrician. To study the indications for Fetal Cord Blood Sampling in high risk pregnancy patients in the last 20years at a tertiary referral center in India. Women referred to the Fetal Medicine Clinic for fetal blood sampling from January 1990 to November 2009, were assessed. An informed consent was taken. Under continuous ultrasound guidance, a 22 gauge long spinal needle was inserted through the maternal abdomen and uterine wall into the umbilical cord, and about 2-4ml of blood, depending on the indication was aspirated by syringe. The various indications for fetal blood sampling in 1342 women were analyzed. Cord blood sampling was performed for the following indications: Hb in Rh Isoimmunized pregnancies-553 cases, Chromosomal analysis-427 cases, non-immune hydrops/pleural effusion/ascites-cases 88, Congenital Infections-131 cases, Intrauterine Growth Restriction-51 cases, Thalassemia-53 cases, Hemophilia-36 cases, and for Thyroid function test for fetal goiter in 3 cases, in total 1,342 women. There were several absolute indications for fetal cord blood sampling in high risk pregnant women, to provide state-of-the-art information on the health of the fetus. Awareness of the procedure and indications for the same should be known to every obstetrician as it is technically feasible, expertise is available in India; so that women who require the procedure may be referred in time.

Mortalidade materna por pré-eclâmpsia/eclâmpsia em um estado do Sul do Brasil

to identify the profile, tendency and causes of maternal death by pre-eclampsia/eclampsia in Paraná. descriptive, transversal cohort study on maternal death by pre-eclampsia/eclampsia from 1997 to 2005. Data were obtained from case studies prepared by Maternal Death Committees that employ the Reproductive Age Mortality Survey Method to examine all the cases of death among women in fertile age. The general and specific maternal death rate (MDR) by pre-eclampsia/eclampsia were considered. To evaluate the tendency, triennial periods have been compared, two by two, taking into consideration the MDR of each period (p<0.05). In the triennial period from 2003 to 2005, 56 deaths by pre-eclampsia/eclampsia were analyzed. The variables focused were: age, income, schooling, gestation number and complications, pre-natal conditions, signs and symptoms related to the condition, delivery route, the time gestation was interrupted, the newborn conditions, access and treatment, ability to avoid and prevention measures. the general triennial MDR has presented significant decline, with 64.3/100,000 born-alive babies. There has been stability along the period for MDR by hypertensive disorder, with MDR of 11.8/100,000 born-alive. Primiparous women, women over 40 and with low socio-economical status have presented higher risks. In relation to the treatment, there has been underuse or inadequate use of conventional medicines for severe pre-eclampsia and eclampsia. The committees' analysis indicated that all the maternal death due to these conditions could have been avoided. actions aiming at minimizing the set of causes that lead to death by pre-eclampsia in Paraná should be enforced, including the training and monitoring of health professionals in order to apply the treatment protocols, besides the formalization of a reference net of clinics and hospitals, qualified for the care of high risk pregnancy and its intercurrences, to which pre-natal pregnant women are enrolled.