Severity of preeclampsia: data from a high specialty hospital in Mexico City

Main Article Content

Juan Gustavo Vázquez-Rodríguez http://orcid.org/0000-0003-3145-1157
Lucila Ofelia Sánchez-Brito http://orcid.org/0000-0001-6860-5290

Keywords

Pregnancy, Critical Care, Pre-Eclampsia

Abstract

Background: The severity of preeclampsia may vary according to the features of the population being studied.


Objective: Identify the frequency and type of data related to severity of pre-eclampsia in patients treated in a highly specialized medical unit in Mexico City.


Material and methods: Observational, retrospective and cross-sectional study, which included a series of 100 pregnant patients with severe pre-eclampsia, attended at a third level care center in Mexico City, from August 1 to December 31, 2018. Data collected on severity of preeclampsia corresponds to that described by the American College of Gynecology and Obstetrics in 2013 and 2019. Variables were ordered into quantitative and qualitative. Descriptive statistics were used with the SPSS version 20 program.


Results: Maternal age 30.45 ± 6.95 years and gestational age 33.03 ± 4.09 weeks. Quantitative data: systolic blood pressure ≥ 160 mm Hg was found in 78%, diastolic blood pressure ≥ 110 mmHg 35%, aspartate aminotransferase > 70 U/L 33%, lactic dehydrogenase > 600 U/L 32%, platelet count < 100,000 platelets/µL 30% and serum creatinine > 1.1 mg/dl 8%. Qualitative data: headache 61%, epigastric pain 37%, hyperreflexia 33%, pain in the right hypochondrium 8%, tinnitus 7%, phosphenes 7%, eclampsia 3%, blurred vision 2%, unbroken liver hematoma 1%, and amaurosis 1 %. No cases of maternal death occurred. 


Conclusions: Most frequent severity data were quantitative values (systolic and diastolic blood pressure) related to symptoms and neurological signs of vasospasm (headache, hyperreflexia), and to symptoms of hepatic origin (epigastric pain, pain in the right hypochondrium).

Abstract 208 | PDF (Spanish) Downloads 286 HTML (Spanish) Downloads 133

References

1. Guía de Práctica Clínica. Actualización 2017. Prevención, diagnóstico y tratamiento de la preeclampsia en el segundo y tercer nivel de atención. México:Secretaría de Salud;2017. Disponible en:http://www.cenetec.salud.gob.mx/contenidos/gpc/catalogoMaestroGPC.html

2. Consejo Nacional de Evaluación de la Política de Desarrollo Social. Evaluación estratégica sobre mortalidad materna en México 2010:características sociodemográficas que obstaculizan a las mujeres embarazadas su acceso efectivo a instituciones de salud. México, D.F.:CONEVAL;2012. Disponible en:https://www.coneval.org.mx/Informes/Evaluacion/Mortalidad%20materna%202010/INFORME_MORTALIDAD_MATERNA.pdf

3. Organización Mundial de la Salud. Mortalidad materna. Nota descriptiva No. 348. Ginebra, Suiza:OMS;2015. Disponible en:www.who.int/mediacentre/factsheets/fs348/es/

4. Cunningham FG, Lindheimer MD. Hypertension in pregnancy. N Engl J Med. 1992;326(14):927-32.

5. Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol. 2013;25(2):124-32. doi:10.1097/GCO.0b013 e32835e0ef5

6. Phyllis A, Sibai B. Preeclampsia:clinical features and diagnosis. UpToDate;2020. [citado mayo 17 2019]. Disponible en:https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis/print

7. American College of Obstetricians and Gynecologists (ACOG). Task Force on Hypertension in Pregnancy. Washington, D.C.:ACOG;2013. Disponible en:https://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy

8. ACOG Practice Bulletin No. 202:Gestational hypertension and preeclampsia. Obstet Gynecol. 2019;133(1):e1-e25. doi:10.1097/AOG.0000000000003018

9. Prieto JA, Mastrobattista JM, Blanco JD. Coagulation studies in patients with marked thrombocytopenia due to severe preeclampsia. Am J Perinatol. 1995;12(3):220-2. doi:10.1055/s-2007-994457

10. Minakami H, Oka N, Sato T, Tamada T, Yasuda Y, Hirota N. Preeclampsia:a microvesicular fat disease of the liver?Am J Obstet Gynecol. 1988;159(5):1043-7. doi:10.1016/0002-9378(88)90407-3

11. Walters BN. Preeclamptic angina —a pathognomonic symptom of preeclampsia. Hypertens Pregnancy. 2011;30(2):117-24. doi:10.3109/10641950903115020

12. Bauer ST, Cleary KL. Cardiopulmonary complications of pre-eclampsia. Semin Perinatol. 2009;33(3):158-65. doi:10.1053/j.semperi.2009.02.008

13. Shah AK, Rajamani K, Whitty JE. Eclampsia:a neurological perspective. J Neurol Sci. 2008;271(1-2):158-67. doi:10.1016/j.jns.2008.04.010

14. Roos NM, Wiegman MJ, Jansonius NM, Zeeman GG. Visual disturbances in (pre)eclampsia. Obstet Gynecol Surv. 2012;67(4):242-50. doi:10.1097/OGX.0b013e318250a457

15. Cluver C, Novikova N, Koopmans CM, West HM. Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term. Cochrane Database Syst Rev. 2017;(1):CD009273. doi:10.1002/14651858.CD009273.pub2

16. World Health Organization. WHO Recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva, Switzerland:WHO;2018. Disponible en:http://www.ncbi.nlm.nih.gov/books/NBK140561/

17. Vázquez-Rodríguez JG, Barboza-Alatorre DY. Resultados maternos y perinatales del tratamiento expectante de la preeclampsia grave. Rev Med Inst Mex Seguro Soc. 2018;56(4):379-86.

18. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking:systematic review of controlled studies. BMJ. 2005;330(7491):565-7. doi:10.1136/bmj.38380.674340.E0

19. Dawson LM, Parfrey PS, Hefferton D, Dicks EL, Cooper MJ, Young D, et al. Familial risk of preeclampsia in Newfoundland:a population-based study. J Am Soc Nephrol. 2002;13(7):1901-6. doi:10.1097/01.asn.0000017224.24670.82

20. Olaya-Garay SX, Velásquez-Trujillo PA, Vigil-De Gracia P. Blood pressure in adolescent patients with pre-eclampsia and eclampsia. Int J Ginecol Obstet. 2017;138(3):335-9. doi:10.1002/ijgo.12237

21. Curiel-Balsera E, Prieto-Palomino MA, Muñoz-Bono J, Ruiz de Elvira MJ, Galeas JL, Quesada García G. Análisis de la morbimortalidad materna de las pacientes con preeclampsia grave, eclampsia y síndrome HELLP que ingresan en una unidad de cuidados intensivos gineco-obstétrica. Med Intensiva. 2011;35(8):478-83. doi:10.1016/j.medin.2011.05.011.