Prediction of Adverse Maternal and Fetal Outcome in Preeclampsia Using a Risk Prediction Model Prospective Cohort Study

Abstract

Introduction: Preeclampsia (PE) is a syndrome unique to pregnancy that ranks second globally in terms of maternal mortality (14% in India and 29.54% globally). PE complicates 2–8% of pregnancies, while 10% of women experience hypertensive problems during pregnancy [hypertensive disorders in pregnancy (HDP)]. For women to have better maternal and perinatal outcomes, we must swiftly identify HDPs. The prognosis of these patients is contingent upon prompt identification, prompt referral to the tertiary care facility, patient accessibility to the facility, and careful management. Materials and methods: Enrolled in the study were patients who met the inclusion and exclusion criteria and gave their consent for the current investigation. To get the risk of unfavorable outcomes for both mother and fetus, we employed the complete preeclampsia integrated estimate of risk score (PIERS) calculator. All patients were intensively monitored and managed accordingly with antihypertensive and steroids for fetal lung maturation in patients needing preterm delivery. Results and discussion: All patients requiring premature birth were closely observed and treated with antihypertensive medications and steroids to promote fetal lung maturation. About 33.33% of the patients in our study with hypertensive diseases of pregnancy experienced adverse maternal outcomes. The full-PIERS prediction model applied to the study population demonstrated a statistically significant p-value of <0.05 in the prediction of adverse maternal and fetal outcomes. The area under the curve (AUC) [receiver operating characteristic (ROC)] for the PIER score at various cutoffs is C = 0.903, with a 95% confidence interval (CI) of 0.855–0.951 and a standard error (SE) of 0.024. The optimal cutoff points are 2.85 for maternal outcomes and 0.95 for fetal outcomes, respectively, in order to maximize (sensitivity + specificity). Conclusion: Our results may help with decision-making when it comes to scheduling the patient’s delivery, maintaining conservative treatment, administering blood products, or moving the patient to an intensive care unit. PIER score is a highly reliable indicator (p < 0.001) for predicting the health of the mother and fetus.