Clinical profile, maternal and fetal mortality analysis of severe gestosis admitted to the ICU

Abstract

Introduction: Pre-eclampsia is a severe multisystemic disease that may occur in pregnancy or in the immediate postpartum period. Methods: We included prospectively women admitted to the ICU with the diagnosis of severe gestosis, from January 1998 to October 2007. We define pre-eclampsia, eclampsia and HELLP syndrome as used by the American College of Obstetrics and Gynecology. Qualitative variables are shown as a percentage and quantitative variables as mean +/- standard deviation or median and interquartile range. We used the chi-square test, t test and multivariate testing for statistical analysis of the data. Results: We report data from 262 women. Median age was 31 years (27 to 34). The admission diagnosis was pre-eclampsia 77.48%, eclampsia 6.11% and HELLP syndrome 16.41%. Complications registered were pulmonary oedema 9%, coagulopathy 2% and renal failure 5%. Delivery was by cesarean in 89.69%. The median newborn weight was 1,500 mg (1,000 to 2,140). We did not find significant difference on systolic pressure between preeclampsia, eclampsia or HELLP nor in uric acid levels. Gestational age was significantly lower in pre-eclampsia than in eclampsia or HELLP (P <0.0001) and, additionally, the weights of the newborn were significantly lower in pre-eclampsia versus eclampsia and HELLP. Maternal mortality was 1.5% and fetal mortality 16.3%. Maternal death is associated with complications in the ICU (renal failure, heart failure or coagulopathy) (P <0.034), OR 6.55 (95% CI 0.89 to 48.12), but multivariate analysis shows only coagulopathy as an independent mortality risk factor (P <0.026), OR 30.3 (95% CI 1.5 to 609.8). Fetal mortality is associated in multivariate analysis with newborn weight <1 kg (P = 0.026), OR 4.1 (95% CI 1.1 to 14.3), and higher gestational age at delivery is protective (P = 0.001), OR 0.68 (95% CI 0.54 to 0.85). Conclusions: Women admitted to the ICU are mostly 31 years old, in the 32-week gestational age of their first pregnancy. In our environment, delivery mostly occurs in the following 5 to 7 days of admission. Maternal mortality is low, but not so fetal mortality that rises up to 16,3%. Maternal mortality is associated with complications such as coagulopathy, and fetal mortality mostly with gestational age and low birth weight.