Yen Tin-Wing, Payne Beth, Qu Ziguang, Hutcheon Jennifer A, Lee Tang, Magee Laura A, Walters Barry N, von Dadelszen Peter
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC.
J Obstet Gynaecol Can. 2011 Aug;33(8):803-809. doi: 10.1016/S1701-2163(16)34983-0.
Preeclampsia is a leading cause of maternal morbidity. The clinical challenge lies in predicting which women with preeclampsia will suffer adverse outcomes and would benefit from treatment, while minimizing potentially harmful interventions. Our aim was to determine the ability of maternal symptoms (i.e., severe nausea or vomiting, headache, visual disturbance, right upper quadrant pain or epigastric pain, abdominal pain or vaginal bleeding, and chest pain or dyspnea) to predict adverse maternal or perinatal outcomes.
We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a multicentre, prospective cohort study designed to investigate the maternal risks associated with preeclampsia. Relative risks and receiver operating characteristic (ROC) curves were assessed for each preeclampsia symptom and outcome pair.
Of 2023 women who underwent assessment, 52% experienced at least one preeclampsia symptom, with 5.2% and 5.3% respectively experiencing an adverse maternal or perinatal outcome. No symptom and outcome pair, in either of the maternal or perinatal groups, achieved an area under the ROC curve value > 0.7, which would be necessary to demonstrate a discriminatory predictive value.
Maternal symptoms of preeclampsia are not independently valid predictors of maternal adverse outcome. Caution should be used when making clinical decisions on the basis of symptoms alone in the preeclamptic patient.
子痫前期是孕产妇发病的主要原因。临床面临的挑战在于预测哪些子痫前期患者会出现不良结局并能从治疗中获益，同时尽量减少潜在的有害干预措施。我们的目的是确定孕妇症状（即严重恶心或呕吐、头痛、视觉障碍、右上腹疼痛或上腹部疼痛、腹痛或阴道出血以及胸痛或呼吸困难）预测孕产妇或围产儿不良结局的能力。
我们使用了PIERS（子痫前期风险综合评估）研究的数据，这是一项多中心前瞻性队列研究，旨在调查与子痫前期相关的孕产妇风险。对每对子痫前期症状和结局评估相对风险及受试者工作特征（ROC）曲线。
在接受评估的2023名女性中，52%经历了至少一种子痫前期症状，分别有5.2%和5.3%经历了孕产妇或围产儿不良结局。无论是孕产妇组还是围产儿组，均没有任何症状和结局对的ROC曲线下面积值>0.7，而这是证明有鉴别预测价值所必需的。
子痫前期的孕妇症状并非孕产妇不良结局的独立有效预测指标。在仅根据症状对子痫前期患者做出临床决策时应谨慎。
