Article

Preeclampsia as a cause of preterm and late preterm (near-term) births

Department of Obstetrics and Gynecology, University of Cincinnati, OH, USA.
Seminars in Perinatology (Impact Factor: 2.42). 02/2006; 30(1):16-9. DOI: 10.1053/j.semperi.2006.01.008
Source: PubMed

ABSTRACT Gestational hypertension-preeclampsia is the most common medical disorder of pregnancy. It is also a major cause of maternal and perinatal morbidities. The majority of adverse pregnancy outcomes occur in patients who develop severe hypertension or severe preeclampsia, and in those who develop the clinical manifestations before 34 weeks' gestation. There is some concern regarding neonatal morbidity in the late preterm (near term) infant (34 0/7 through 36 6/7 weeks' gestation) as a result of gestational hypertension and preeclampsia. A review of the available data suggests that most deliveries of the late preterm infant in such women are justified because of the concerns about maternal and fetal safety with continued gestation. In addition, the rate of preterm delivery at 34 to 36 weeks' gestation in women with gestational hypertension or preeclampsia is low. Indeed, most admissions to Neonatal Intensive Care Unit in such pregnancies occur in those at > or =37 weeks' gestation. There is urgent need for research to assess the reasons behind preterm delivery at 34 to 36 weeks' gestation in women with hypertension and preeclampsia. In addition, there is need for research to assess the reasons for admission to the NICU in term infants born of mothers with varying severities of hypertension and preeclampsia. In this paper, the phrase "late-preterm" has been used instead of "near term," as the former was considered more appropriate to reflect this subgroup of preterm infants in a workshop on this topic held in July 2005, organized by the National Institute of Child Health and Human Development.

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    • "The etiology of pre-eclampsia is elusive [13] and management depends on early detection, antihypertensive treatment, seizure prophylaxis and rapid delivery in severe cases [1]. Pre-eclampsia is a leading cause of iatrogenic premature delivery [14, 15]. Because pre-eclampsia is a progressive disorder, delivery minimizes severe maternal morbidity although it increases neonatal morbidity and mortality because of prematurity [16]. "
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    ABSTRACT: Pre-eclampsia, which is more prevalent in resource-limited settings, contributes significantly to maternal, fetal and neonatal morbidity and mortality. However, the factors associated with these adverse outcomes are poorly understood in low resource settings. In this paper we examine the risk factors for adverse neonatal outcomes among women with pre-eclampsia at Mulago Hospital in Kampala, Uganda. Pre-eclampsia, which is more prevalent in resource-limited settings, contributes significantly to maternal, fetal and neonatal morbidity and mortality. However, the factors associated with these adverse outcomes are poorly understood in low resource settings. In this paper we examine the risk factors for adverse neonatal outcomes among women with pre-eclampsia at Mulago Hospital in Kampala, Uganda. PREDICTORS OF ADVERSE NEONATAL OUTCOMES WERE: preterm delivery (OR 5.97, 95% CI: 2.97-12.7) and severe pre-eclampsia (OR 5.17, 95% CI: 2.36-11.3). Predictors of adverse neonatal outcomes among women with pre-eclampsia were preterm delivery and severe pre-eclampsia. Health workers need to identify women at risk, offer them counseling and, refer them if necessary to a hospital where they can be managed successfully. This may in turn reduce the neonatal morbidity and mortality associated with pre-eclampsia.
    01/2014; 17(Suppl 1):7. DOI:10.11694/pamj.supp.2014.17.1.3014
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    • "Eclampsia is the occurrence of tonic-clonic seizures in pregnancy or the puerperium that cannot be explained by another cause, such as epilepsy—the commonest reason for seizures in pregnant women. Eclamptic convulsions occur in around 2-3% of patients with preeclampsia [5] [32] and may be the presenting feature of this condition. Premonitory symptoms and signs—including headache, visual changes, hypertension, epigastric discomfort, and proteinuria—are present in up to four-fifths of subsequently eclamptic patients [19], although most patients with these features will not fit. "
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    ABSTRACT: The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality arising from these conditions, for women and their infants alike. This paper outlines the evidence base for contemporary management principles pertaining to the neurological sequelae of preeclampsia, primarily from the maternal perspective, but with consideration of fetal and neonatal aspects as well. It concludes with a discussion regarding future directions in the management of this potentially lethal condition.
    Obstetrics and Gynecology International 12/2013; 2013:985606. DOI:10.1155/2013/985606
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    ABSTRACT: Objective: To compare the maternal and neonatal outcomes of pregnancies with pre-eclampsia to those with normotensive. Materials and Methods: Cases were defined as pregnancies with pre-eclampsia who delivered between January 1 st , 2009 and December 31 st , 2009 at Khon Kaen Hospital and were compared with normal blood pressure with a ratio of 1:1 match for age and date of delivery. The information of maternal and neonatal outcomes were reviewed from the medical and delivery records. Adjusted odds ratio with 95% confidence intervals were used to evaluate the effect of pre-eclampsia. Results: There were 302 cases in the study which half of them were pre-eclampsia and the others were normotensive pregnancies. Maternal and neonatal morbidities were significantly higher in pre-eclampsia pregnancies. Pre-eclampsia increases the risk of vaginal operative delivery (adjusted OR 2.6, 95% CI 1.1-5.9), cesarean section (adjusted OR 1.8, 95% CI 1.1-3.0), low birth weight (< 2,500 g) (adjusted OR 2.9, 95% CI 1.4-5.8), and birth asphyxia (adjusted OR 5.3, 95% CI 1.1-25.1). The most common indication for cesarean section was fetal distress. There were eight neonatal deaths. The causes of death were respiratory distress syndrome, sepsis and very low birthweight. Conclusion: Pre-eclampsia significantly increased the risk of adverse maternal and neonatal outcomes.
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