Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation, a case series

被引：32

作者：

van Oostwaard, M. F. ^{[1
]}

van Eerden, L. ^{[2
]}

de Laat, M. W. ^{[3
]}

Duvekot, J. J. ^{[4
]}

Erwich, J. J. H. M. ^{[5
]}

Bloemenkamp, K. W. M. ^{[6
]}

Bolte, A. C. ^{[7
]}

Bosma, J. P. F. ^{[8
]}

Koenen, S. V. ^{[9
]}

Kornelisse, R. F. ^{[10
]}

Rethans, B. ^{[3
]}

Heimel, P. van Runnard ^{[11
]}

Scheepers, H. C. J. ^{[12
]}

Ganzevoort, W. ^{[3
]}

Mol, B. W. J. ^{[13
]}

de Groot, C. J. ^{[14
]}

Gaugler-Senden, I. P. M. ^{[15
]}

机构：

[1] IJsselland Ziekenhuis, Dept Obstet & Gynaecol, Capelle Aan Den Ijssel, Netherlands

[2] Maasstad Ziekenhuis, Dept Obstet & Gynaecol, Rotterdam, Netherlands

[3] Acad Med Ctr, Dept Obstet & Gynaecol, Amsterdam, Netherlands

[4] Erasmus MC, Dept Obstet & Gynaecol, Rotterdam, Netherlands

[5] Univ Groningen, Univ Med Ctr Groningen, Dept Obstet & Gynaecol, Groningen, Netherlands

[6] Leids Univ, Med Ctr, Dept Obstet & Gynaecol, Leiden, Netherlands

[7] Radboud Univ Nijmegen, Med Ctr, Dept Obstet & Gynaecol, Nijmegen, Netherlands

[8] Isala Ziekenhuis, Dept Obstet & Gynaecol, Zwolle, Netherlands

[9] Univ Med Ctr Utrecht, Dept Obstet & Gynaecol, Utrecht, Netherlands

[10] Erasmus MC, Dept Paediat, Rotterdam, Netherlands

[11] Maxima Med Ctr, Dept Obstet & Gynaecol, Veldhoven, Netherlands

[12] Maastricht Univ, Med Ctr, Dept Obstet & Gynaecol, Maastricht, Netherlands

[13] Univ Adelaide, Sch Paediat & Reprod Hlth, Adelaide, SA, Australia

[14] Vrije Univ Amsterdam, Med Ctr, Dept Obstet & Gynaecol, Amsterdam, Netherlands

[15] Jeroen Bosch Ziekenhuis, Dept Obstet & Gynaecol, Shertogenbosch, Netherlands

来源：

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY | 2017年 / 124卷 / 09期

关键词：

Maternal and neonatal outcome; preterm birth; prolongation; severe pre-eclampsia;

D O I：

10.1111/1471-0528.14512

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

Objective To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation. Design Nationwide case series. Setting All Dutch tertiary perinatal care centres. Population All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014. Methods Women were identified through computerised hospital databases. Data were collected from medical records. Main outcome measures Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival). Results We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days. Conclusions Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling.

引用

页码：1440 / 1447

页数：8

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