HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Menzies, J. Search for Related Content PubMed PubMed Citation Articles by Menzies, J. Related Collections Epidemiology/public health Hypertension and PIH Maternal/fetal physiology Medical complications of pregnancy Pediatrics/neonatology

Instituting Surveillance Guidelines and Adverse Outcomes in Preeclampsia

From the Departments of ¹Obstetrics and Gynaecology, ²Health Care and Epidemiology, and ³Medicine, and the ⁴CFRI Centre for Healthcare Innovation and Improvement, University of British Columbia, Vancouver, British Columbia; ⁵Department of Ambulatory Care and Prevention, Harvard Medical School, Cambridge, Massachusetts; ⁶Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia; and ⁷Department of Paediatrics and iCARE, University of Alberta, Alberta, Canada.

OBJECTIVE: To assess the incidence of combined adverse maternal and perinatal outcomes in women with preeclampsia before and after introducing standardized assessment and surveillance.

METHODS: This study was a preintervention (retrospective) compared with a postintervention (prospective) cohort comparison in a single-tertiary, perinatal unit that included women admitted to hospital with preeclampsia. We interrogated an existing retrospective 24-month database and then introduced the guidelines, assessing the incidence of the combined adverse maternal and perinatal outcomes for 41 months (September 2003 through February 2007). Tests of organ (dys)function were performed at least as often as on the day of admission, admission day +1, every Monday and Thursday, day of delivery, and delivery day +1. All data were checked for errors. The combined maternal outcome was maternal death or one or more of hepatic failure, hematoma, or rupture, Glasgow coma score of less than 13, stroke, at least two seizures, cortical blindness, need for positive inotrope support, myocardial infarction, infusion of any third antihypertensive, renal dialysis, renal transplantation, at least 50% FIO₂ for greater than 1 hour, intubation, or transfusion of at least 10 units of blood products. The combined perinatal outcome was perinatal or infant mortality, bronchopulmonary dysplasia, necrotizing enterocolitis, grade III/IV intraventricular hemorrhage, cystic periventricular leukomalacia, or stage 3–5 retinopathy of prematurity.

RESULTS: Two hundred ninety-five and 405 women were in the preintervention and postintervention cohorts, respectively. The incidence of adverse maternal outcome fell (5.1% to 0.7%; Fisher P<.001; odds ratio 0.14, 95% confidence interval 0.04–0.49). Perinatal outcomes did not change.

CONCLUSION: Standardized surveillance of women with preeclampsia was associated with reduced maternal risk.

LEVEL OF EVIDENCE: II