Incidence Of Adverse Maternal Outcomes Research Articles

Incidence of Adverse Maternal Outcomes Among Pregnant Health Care Workers [ID 2683462

INTRODUCTION: The objective of this study was to examine whether pregnant health care workers at are increased risk for adverse maternal outcomes in pregnancy. METHODS: A retrospective cohort study from 2008 to 2023 was conducted using TriNetX Research platform (de-identified patient data from a network of health care organizations) to identify pregnant health care workers. Using ICD codes, CPT codes, and LOINC codes, individuals were diagnosed with the presence or absence of the following conditions: fetal growth restriction, gestational diabetes mellitus, chronic hypertension, gestational hypertension, preeclampsia (with and without severe features), and postpartum depression. Descriptive statistics were used to analyze the data. The University of Texas Medical Branch IRB approved this study as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. RESULTS: Among 1,553,793 patients, 34,099 were health care workers. Health care workers had increased incidences for the following adverse maternal outcomes: diet-controlled gestational diabetes (12.88% versus 9.95%; P<.001), oral hypoglycemic agent-controlled gestational diabetes (1.56% versus 1.02%; P<.001), insulin-controlled gestational diabetes (2.88% versus 1.73%; P<.001), gestational hypertension (3.04% versus 2.73%; P<.001), and preeclampsia with severe features (5.95% versus 4.23%; P<.001). Health care workers were at decreased incidences for fetal growth restriction, preeclampsia without severe features, and postpartum hemorrhage. CONCLUSION: Given that health care workers are at increased risk of several adverse maternal outcomes, it may be important for providers to screen health care workers more frequently for these adverse outcomes. Additional studies will need to be conducted using current identifiable electronic medical records.

Severe postpartum hemorrhage and the risk of adverse maternal outcome: A comparative analysis of two population-based studies in France and the Netherlands

ObjectivesAmong women with severe PPH (sPPH) in France and the Netherlands, we compared incidence of adverse maternal outcome (major obstetric hemorrhage (≥2.5L blood loss) and/or hysterectomy and/or mortality) by mode of delivery. Second, we compared use and timing of resuscitation and transfusion management, second-line uterotonics and uterine-sparing interventions (intra-uterine tamponade, compression sutures, vascular ligation, arterial embolization) by mode of delivery. MethodsSecondary analysis of two population-based studies of women with sPPH in France and the Netherlands. Women were selected by a harmonized definition for sPPH: (total blood loss ≥ 1500 ml) AND (blood transfusion of ≥ 4 units packed red blood cells and/or multicomponent blood transfusion). FindingsIncidence of adverse maternal outcome after vaginal birth was 793/1002, 9.1 % in the Netherlands versus 88/214, 41.1 % in France and 259/342, 76.2% versus 160/270, 59.3% after cesarean. Hemostatic agents such as fibrinogen were administered less frequently (p < 0.001) in the Netherlands (vaginal birth: 83/1002, 8.3% versus 105/2014, 49.5% in France; cesarean: 47/342, 13.7% and 152/270, 55.6%). Second-line uterotonics were started significantly later after PPH-onset in the Netherlands than France (vaginal birth: 46 versus 25 min; cesarean: 45 versus 18 min). Uterine-sparing interventions were less frequently (p < 0.001) applied in the Netherlands after vaginal birth (394/1002,39.3 %, 134/214, 62.6%) and cesarean (133/342, 38.9 % and 155/270, 57.4%), all initiated later after onset of refractory PPH in the Netherlands. InterpretationIncidence of adverse maternal outcome was higher among women with sPPH in the Netherlands than France regardless mode of birth. Possible explanatory mechanisms are earlier and more frequent use of second-line uterotonics and uterine-sparing interventions in France compared to the Netherlands.

The Effect of Ischemic Heart Diseases in Maternal Outcome- A Retrospective Cohort Study

Introduction: In women with heart disease, maternal mortality is reported to be much higher than average and the risk appears to be increasing. In western countries heart disease is the major cause of maternal death. The full spectrum of structural heart disease including congenital heart disease (CHD), valvular heart disease (VHD), and cardiomyopathy (CMP), and also ischemic heart disease (IHD) may be encountered in pregnant women. Aim of the study: The aim of this study was to determine the impact of ischemic heart diseases on maternal adverse outcome during pregnancy. Methods: This was a retrospective cohort study and was conducted in the Department of Gynaecology and Obstetrics of Kushtia General Hospital, Kushtia, Bangladesh during the period from January, 2021 to January, 2022. There was total 100 women in our study. This study was conducted among pregnant women with ischemic heart disease. The study population was categorized into two; namely, Group A -women with IHD(n=50) and Group B - women without IHD (n=50). Result: In total 100 patients from both the groups completed the study. In our study we found the mean ± SD age of pregnant mothers in Group A was (30.01 ± 5.00) and in Group B (27.05 ± 5.04) respectively. The mean± SD of BMI for women in Group A was (27.47 ± 4.40) and in Group B (28.34 ± 5.67) respectively. The prevalence of Hypertension was found in 41(82%) &amp; 21 (42%) and DM was 68% &amp; 36%among Group A &amp; B respectively. Transient Ischemic Attack &amp; Stroke was found 46% &amp; 16 % in Group A respectively. Arrythmia was only found in Group A by 36% &amp; 28%. Conclusion: In our study, we found that the incidence of adverse maternal outcomes was higher among women with IHD. Pregnant women with IHD have a higher risk of maternal and fetal complications compared with women without HD. Cardiomyopathy, hypertension, and arrhythmias were independently associated with higher rates of major adverse maternal events was found in our study.

The effect of preeclampsia on adverse maternal outcomes in Sidama region, Ethiopia: a prospective open cohort study

Ethiopia has made improvements in the reduction of maternal mortality; the high burden of preeclampsia remains a concern in the Sidama region. This study aimed to measure the effect of preeclampsia on adverse maternal outcomes and identify risk factors among women with preeclampsia in Sidama region. A prospective open cohort study was conducted from August 8, 2019, to October 1, 2020. We enrolled a total of 1015 the pregnant women who had preeclampsia and normotensive women at ≥ 20 weeks of gestation and followed them until 42 days after delivery. A log-binomial logistic regression model was used to estimate the incidence of adverse maternal outcomes and its risk factors. There were 276 adverse maternal outcomes observed in the preeclampsia group compared to 154 adverse maternal outcomes in the normotensive group (P < 0.001). Women with severe features of preeclampsia had a 43% (aRR = 1.43, 95% CI 1.3–1.58) higher risk for adverse maternal outcomes compared to women without severe features of preeclampsia. Women without severe features of preeclampsia had a 39% (aRR = 1.39, 95% CI 1.2–1.76) higher risk for adverse maternal outcomes compared to women in the normotensive group. More adverse maternal outcomes occurred among women with preeclampsia after controlling for confounders.

Effect of grand multiparity on adverse maternal outcomes: A prospective cohort study.

BackgroundGrand multiparity remains a risk factor for a wide range of obstetric complications, especially in developing countries. Grand multiparity has been shown to increase the risks of medical and obstetric complications during pregnancies. However, in a research setting, the risk factors associated with adverse maternal outcomes have yet to be adequately investigated among grand multiparity. Furthermore, there is limited information that examines the effect of grand multiparity on pregnancy outcomes in Ethiopia through prospective follow-up design.ObjectiveThis study aimed to investigate the effect of grand multiparity on pregnancy outcomes in selected public hospitals in the Sidama Region State of Ethiopia.MethodsA prospective cohort study design was employed on 837 pregnant women who were admitted for delivery in selected public hospitals from January 1 to August 31, 2021. The study subjects were recruited during admission for labor and delivery. Every woman who was admitted to labor wards was screened for eligibility. The exposed group in this cohort was grand multiparity, and the non-exposed group was multiparity. Data collection was started from the first contact after admission and follow-up to discharge for adverse maternal outcomes. The risk factors for adverse maternal outcomes in grand multiparity were investigated using multivariable Poisson regression analysis. The risk factor was reported as an adjusted risk ratio (ARR) with a 95% confidence interval (CI). When the P-value was <0.05, statistical significance was declared.ResultsThe cohort's overall cumulative incidence of adverse maternal outcomes were 39.9% (95%CI: 36.6, 43.4%). Among exposed groups, the incidence of adverse maternal outcomes were 47.1% (95%CI: 41.0–53.2) and 36.3% (95% CI: 32.3–40.6) the multiparity. When compared to multiparous women, grand multiparity was associated with a greater risk of postpartum hemorrhage (ARR = 2.1; 95%CI:1.6–2.7) and malpresentation (ARR = 1.3; 95% CI: 1.01–1.7).ConclusionsPregnant women with grand multiparity have a higher incidence of adverse maternal outcomes. Grand multiparity increased the risk of adverse maternal outcomes such as postpartum bleeding and malpresentation. In low-resource settings, we recommend that community health education, the provision of accessible and effective contraceptive services, and increased awareness of the adverse maternal outcome among grand multiparity during pregnancy on obstetric performance should be prioritized. Also, trained health providers can effectively decrease the risk factor with good antenatal care and delivery.

Discuss the Application of Data Services in Data Health Management of High-Risk Pregnant and Lying-In Women in Smart Medical Care.

Objective In order to improve the refined management of hospitals, promote the scientific development of smart hospitals in medical institutions, and solve the problem of data filling and reporting that is increasing year by year in the country, province, and city. Methods A total of 84 high-risk pregnant women admitted to our hospital from January 2020 to October 2021 were selected and screened for high-risk pregnant women. Risk pregnant women were divided into a routine intervention group and a DS medical group, with 42 cases in each group. High-risk pregnant women in the routine intervention group received routine intervention, and the DS medical group applied data to serve smart medical services on the basis of routine intervention. The scores of self-care, anxiety, and depression were compared between the two groups, the coping styles were analyzed, the satisfaction rate and incidence of adverse conditions of the high-risk puerperae were recorded, and the delivery methods of the two groups were compared. Results After the intervention, the activities of daily living, follow-up, fetal monitoring, and self-protection behaviors in the DS medical group were higher than those in the routine intervention group, and the difference was statistically significant (P < 0.05). The scores of anxiety and depression in the group were lower, with statistical significance (P < 0.05); after the intervention, the scores of negative coping styles in the DS medical group were lower than those in the conventional intervention group, while the scores for positive coping styles were higher than those in the conventional intervention group; the DS medical group had higher risk. The satisfaction of pregnant women was significantly higher than that of the routine intervention group, and the difference was statistically significant (P < 0.05); the overall incidence of adverse maternal outcomes among high-risk pregnant women in the DS medical group was lower than that of the routine intervention group, and the difference was not statistically significant (P > 0.05). Compared with the routine group, the DS medical group had a higher number of vaginal deliveries and a lower number of cesarean deliveries, and the difference was statistically significant (P < 0.05). Conclusion The application of data services in a smart medical high-risk maternity-related data management platform enables the promotion of high-risk pregnant women's self-care behaviors and improves negative emotions, enables them to cooperate in delivery with positive behaviors, and reduces the number of cases of cesarean delivery.

Care of Labour by Trained Midwife and Effect on Maternal Outcome in a Hospital Based Labour Ward

Midwifery service quality affects delivery outcomes the most. The aim of the study was to analyze the maternal outcome of pregnancies managed by the midwives and various factors which can affect the incidence of adverse maternal outcomes. Methodology: This retrospective study at DHQ Hospital MishtiMela Orakzai studied the district's rural midwife-led maternity healthcare system from July 2019 till June 2020. All midwives' cases were recorded and analyzed to establish the frequency of various maternal outcomes. All rural pregnant patients between 15 and 45 who presented to the government facility midwife at any stage of labor were recorded and maternal outcome and related factors were gathered. The aim of the study was to analyze the maternal outcome of pregnancies managed by the midwives and various factors which can affect the incidence of adverse maternal outcomes. Results: In our study, mean age of the patients was 27 SD 5.9 years (from 15 to 45) with gestational age of the patients from 14 to 42 weeks (mean 37.3 SD 2.5 weeks). Among the total 635 cases, 54% of the cases were of the age group 20 to 29 years. Around 19% of the cases in the labor room landed were preterm (&lt;37 weeks of gestation), and 78% of the patients were multigravida. Incidence of LSCS in mid-wife managed pregnancies was 4.1% (26 of 635 cases), and successful vaginal deliveries were carried out in 92.9% cases (590 of 635). Conclusion: Researchers are hopeful that the findings will serve as a solid basis for further research and help them better understand how midwives and expectant mothers communicate and how to strengthen the relationship. These findings can be implemented as the basis for future courses in midwifery education. Efforts should be made to evaluate these educational programmes and their outcomes in the delivery room. Keywords: Mid-wife, LSCS, SVD, Vaginal delivery, Maternal Outcome

Incidence and determinants of adverse outcomes among women who were managed for eclampsia in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundThe incidence of eclampsia and its adverse maternal outcomes are very high in developing countries, particularly in Subsaharan African Countries. Identifying predictors for adverse maternal outcomes of eclampsia has paramount importance for helping health care providers to optimize their management outcomes. Therefore, this study aimed to assess the incidence of adverse maternal outcomes of eclampsia and its determinant factors.MethodsA retrospective follow-up study design was applied. The data were extracted from patient charts using a structured, pre-tested, questionnaire. Descriptive analyses (frequencies, means, and standard deviation) were calculated, and bi-variable and multivariable logistic regression models were used to testing the association between independent variables and an outcome variable. After the data were coded and entered into Epi-Info Version 7.2 Software, the data were analyzed using STATA Version 14 Statistical Software.ResultsThe magnitude of eclampsia was 5.36 per 1000 pregnancies (95% CI: 4.72, 6.10). The incidence of adverse maternal outcomes in eclamptic mothers was 53.7% (95% CI: 47.02, 60.24%). After adjusting for covariates maternal age 30–34, AOR 5.4 [95% CI = 1.02, 28.6]; age above 34, AOR 10.5 [95% CI = 1.3, 88.6]; gravidity 2–4, AOR 0.3 [95% CI = 0.1, 0.9]; 10 or more convulsions, AOR 4.6 [95% CI = 1.4, 14.9]; mild pyrexia, AOR 20.4 [95% CI = 3.7, 112.7]; moderate pyrexia, AOR 14.6 [95% CI = 1.7125.1]; platelet count below 50,000 cells/mm3, AOR 34.9 [95% CI = 3.6, 336.2]; platelet count between 50,000 and 99,000 cells/mm3, AOR 24.5 [95%CI = 5.4111.6]; and stillbirth of the current pregnancy, AOR 23.2 [95%CI = 2.1257.5] were strong predictors of adverse maternal outcomes in eclamptic mothers.ConclusionsThe incidence of adverse maternal outcomes of eclampsia was found to be high compared to similar studies discussed in this study. This study recommends early identification of patients with the risk factors (having many convulsions, high body temperature, low platelet count, patient age above 30 years, and 2–4 pregnancies), strengthening the referral system, and advocation of research on the area of adverse maternal outcomes and thereby encourage evidence-based medicine.

Insignificant Effect of Isolated Hypothyroxinemia on Pregnancy Outcomes During the First and Second Trimester of Pregnancy.

Objective: Adverse maternal outcomes and perinatal complications are associated with overt and subclinical maternal hypothyroidism. It is not clear whether these complications also occur in women with isolated hypothyroxinemia during pregnancy. The aim of this study was to evaluate the effects of isolated hypothyroxinemia on maternal and perinatal outcomes during pregnancy.Methods: This study included data from 2,864 pregnant women in the first trimester (67 women with isolated hypothyroxinemia, 784 euthyroid women) and the second trimester (70 women with isolated hypothyroxinemia, 1,943 euthyroid women) of pregnancy. Maternal serum samples were collected in the first and second trimesters to examine thyroid hormone concentration. Hypothyroxinemia was defined as a normal maternal thyroid-stimulating hormone concentration with a low maternal free thyroxine concentration and negative thyroid autoantibodies. The following maternal outcomes were recorded: gestational hypertension, gestational diabetes mellitus, placenta previa, placental abruption, prelabor rupture of membranes, and premature delivery. Perinatal outcomes, including fetal growth restriction, fetal distress, low birth weight, intrauterine fetal death, and malformation. The incidence of adverse pregnancy outcomes and perinatal complications was compared between women in the first trimester and second trimester with isolated hypothyroxinemia.Results: There were no significant differences in the incidence rates of adverse maternal outcomes and perinatal complications between patients in the first and second trimesters with isolated hypothyroxinemia.Conclusion: The results of this study indicate that isolated hypothyroidism does not increase the incidence of adverse maternal outcomes and perinatal complications.

Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes. To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH. This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019. Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion. Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization. This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results. In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.

Pregestational diabetes: pregnancy planning. Which strategies

In the last years the number of pregestational pregnancies (especially type 2) has been increasing. Several studies have demonstrated that pregestational pregnancies are associated with an increased incidence of adverse maternal outcomes, an increased risk of neonatal mortality and congenital malformations; these risks are related to the glycemic control and to the therapies at the time of conception and during embryogenesis. These pregnancies, therefore, should never be random, as it often happens in our clinics, but they must be planned with pre-conceptional counselling paths dedicated to childbearing women, from puberty, continuing into adolescence and reaching adulthood. When the pregnancy desire becomes concrete, the woman with diabetes must be included in a multidisciplinary and structured program. The pregestational counselling must bring the woman, before conception, to the stabilization of complications, to the therapy improvement, to the achievement of the skills for the management of therapy and to the glycemic control. To reach these results it is necessary that the Diabetologic team works taking into account all the clinical and psycho-social aspects of childbearing women. KEY WORDS pregestational diabetes; pregnancy; preconceptional counselling; maternal and fetal outcomes.

Incidence and risk factors for Preeclampsia in a cohort of healthy nulliparous pregnant women: a nested case-control study

The objective of this study is to determine the incidence, socio-demographic and clinical risk factors for preeclampsia and associated maternal and perinatal adverse outcomes. This is a nested case-control derived from the multicentre cohort study Preterm SAMBA, in five different centres in Brazil, with nulliparous healthy pregnant women. Clinical data were prospectively collected, and risk factors were assessed comparatively between PE cases and controls using risk ratio (RR) (95% CI) plus multivariate analysis. Complete data were available for 1,165 participants. The incidence of preeclampsia was 7.5%. Body mass index determined at the first medical visit and diastolic blood pressure over 75 mmHg at 20 weeks of gestation were independently associated with the occurrence of preeclampsia. Women with preeclampsia sustained a higher incidence of adverse maternal outcomes, including C-section (3.5 fold), preterm birth below 34 weeks of gestation (3.9 fold) and hospital stay longer than 5 days (5.8 fold) than controls. They also had worse perinatal outcomes, including lower birthweight (a mean 379 g lower), small for gestational age babies (RR 2.45 [1.52–3.95]), 5-minute Apgar score less than 7 (RR 2.11 [1.03–4.29]), NICU admission (RR 3.34 [1.61–6.9]) and Neonatal Near Miss (3.65 [1.78–7.49]). Weight gain rate per week, obesity and diastolic blood pressure equal to or higher than 75 mmHg at 20 weeks of gestation were shown to be associated with preeclampsia. Preeclampsia also led to a higher number of C-sections and prolonged hospital admission, in addition to worse neonatal outcomes.

ACOG

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.

Committee Opinion No.692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period: ACOG Committee on Obstetrics Practice Obstet Gynecol. 2017;129(4):e90-95

Severe hypertension is a well-established major contributor to maternal morbidity and mortality during pregnancy and the postpartum period. Evidence based guidelines for the management of hypertension can help reduce the incidence of adverse maternal outcomes.

Committee Opinion No. 692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.

Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.

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

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.

Committee Opinion No. 623: Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period.

Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur in pregnant women or women in the postpartum period. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Once the hypertensive emergency is treated, a complete and detailed evaluation of maternal and fetal well-being is needed with consideration of, among many issues, the need for subsequent pharmacotherapy and the appropriate timing of delivery.

Comparison of perinatal and maternal outcomes of severe preeclampsia, eclampsia, and HELLP syndrome

To compare maternal and perinatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzyme levels, and low platelets) syndrome. Maternal and neonatal charts of 1,222 consecutive pregnancies complicated by severe preeclampsia, eclampsia, or HELLP syndrome at our maternal-perinatal unit were reviewed. Patients were divided into three groups: 903 (73.9%) with severe preeclampsia, 123 (10.1%) with eclampsia, and 196 (16.0%) with HELLP syndrome. The overall incidence of adverse maternal outcome was 5.9%. The rates of adverse maternal outcomes for women with HELLP syndrome and eclampsia were higher than for severe preeclampsia (13.8% vs. 11.4% vs. 3.4%, respectively) (p=0.000). Birth weight was lower in patients with HELLP syndrome than in patients with eclampsia and severe preeclampsia (p=0.005). No significant difference in neonatal morbidity was found among the three groups. Perinatal mortality tended to be higher in the severe preeclampsia group than in the HELLP syndrome and eclampsia groups (p=0.231). Pregnancies complicated by HELLP syndrome had significantly higher maternal morbidity than those with severe preeclampsia and eclampsia. Perinatal and neonatal outcomes in pregnancies complicated by severe preeclampsia, eclampsia, and HELLP syndrome were dependent on gestational age rather than being disease dependent.

Atlantic Diabetes in Pregnancy (DIP): the prevalence and outcomes of gestational diabetes mellitus using new diagnostic criteria

New diagnostic criteria for gestational diabetes mellitus (GDM) have recently been published. We wished to evaluate what impact these new criteria would have on GDM prevalence and outcomes in a predominantly European population. The Atlantic Diabetes In Pregnancy (DIP) programme performed screening for GDM in 5,500 women with an oral glucose tolerance test at 24-28 weeks. GDM was defined according to the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and compared with previous WHO criteria; maternal and neonatal adverse outcomes were prospectively recorded. Of the participants, 12.4% and 9.4% were diagnosed with GDM using IADPSG and WHO criteria, respectively. IADPSG GDM pregnancies were associated with a statistically significant increased incidence of adverse maternal outcomes (gestational hypertension, polyhydramnios and Caesarean section) and neonatal outcomes (prematurity, large for gestational age, neonatal unit admission, neonatal hypoglycaemia and respiratory distress). The odds ratio for the development of these adverse outcomes remained significant after adjustment for maternal age, body mass index and non-European ethnicity. Those women who were classified as having normal glucose tolerance by WHO criteria but as having GDM by IADPSG criteria also had significant adverse pregnancy outcomes. GDM prevalence is higher when using newer IADPSG, compared with WHO, criteria, and these women and their offspring experience significant adverse pregnancy outcomes. Higher rates of GDM pose a challenge to healthcare systems, but improved screening provides an opportunity to attempt to reduce the associated morbidity for mother and child.