Rebahi Houssam, Elizabeth Still Megan, Faouzi Yassine, Rhassane El Adib Ahmed
Cadi-Ayyad University, Faculty of Medicine and Pharmacy of Marrakech, Department of Anesthesia and Intensive Care Medicine, Marrakech, Morocco.
University of Texas Southwestern Medical Center, Clinic of Anesthesiology and Pain Management, Dallas, TX, USA.
Turk J Obstet Gynecol. 2018 Dec;15(4):227-234. doi: 10.4274/tjod.22308. Epub 2019 Jan 9.
In Morocco, eclampsia remains the second major cause of maternal mortality. Conventionally, patients with preeclampsia and neurosensory signs (NSS) (e.g., headaches and hyperreflexia) are considered at high risk of worsening and progressing to eclampsia. However, this specific population is heterogeneous in terms of eclampsia occurrence. We aimed to identify the risk factors for the development of eclampsia in women with preeclampsia presenting with NSS at admission.
We performed a single-center, retrospective case-control study of patients with preeclampsia with positive NSS from January 1, 2012 through December 31, 2015, to investigate predictive factors for eclamptic seizures. The case patients were pregnant women with severe preeclampsia who had NSS before developing eclampsia. Control subjects were those with positive NSS without the development of seizures during their hospital stay. One hundred-thirty eight patients with eclampsia and 272 control patients were enrolled.
Univariate analysis revealed that eclampsia was more likely to develop in patients with the following risk factors: maternal age ≤25 years (χ2=9.58, p=0.002), primiparity (χ2=6.38, p=0.011), inadequate prenatal care (χ2=11.62, p=0.001), systolic hypertension ≥160 mmHg (χ2=15.31, p<0.001), diastolic hypertension ≥110 mmHg (χ2=5.7, p=0.017), generalized acute edema (χ2=14.66, p<0.001), hematocrit <35% (χ2=11.16, p=0.001), serum creatinine >100 μmol/L (χ2=13.46, p<0.001), asparate aminotransferase (AST) >70 IU/L (χ2=10.15, p=0.001), and thrombocytopenia (χ2=22.73, p<0.001). Additionally, independent predictive factors for eclampsia in multivariate analysis included inadequate prenatal care [odds ratio (OR), 8.96 [95% confidence interval (CI): 3.9-20.5], p<0.001), systolic blood pressure ≥160 mmHg (OR, 3.130 [95% CI: 1.342-7.305], p=0.008), thrombocytopenia with a platelet count <50.000 (OR, 13.106 [95% CI: 1.344-127.823], p=0.027), AST ≥70 IU (OR, 3.575 [95% CI: 1.313-9.736], p=0.007), and elevated liver enzymes level, and low platelet count (ELLP) syndrome, which is an incomplete variant of HELLP syndrome (H for hemolysis) (OR, 5.83 [95% CI: 2.43- 13.9], p<0.001).
This work highlights two major risk factors in this patient population, inadequate prenatal care and ELLP syndrome, which can help in the early identification of patients at highest risk of developing eclampsia and guide preventive measures.
在摩洛哥，子痫仍然是孕产妇死亡的第二大主要原因。按照惯例，患有先兆子痫且伴有神经感觉症状（如头痛和反射亢进）的患者被认为有病情恶化并发展为子痫的高风险。然而，这一特定人群在子痫发生方面具有异质性。我们旨在确定入院时伴有神经感觉症状的先兆子痫女性发生子痫的危险因素。
我们对2012年1月1日至2015年12月31日期间伴有阳性神经感觉症状的先兆子痫患者进行了一项单中心回顾性病例对照研究，以调查子痫发作的预测因素。病例患者为重度先兆子痫孕妇，在发生子痫前伴有神经感觉症状。对照对象为神经感觉症状阳性且住院期间未发生子痫的患者。共纳入138例子痫患者和272例对照患者。
单因素分析显示，具有以下危险因素的患者更易发生子痫：产妇年龄≤25岁（χ²=9.58，p=0.002）、初产（χ²=6.38，p=0.011）、产前检查不足（χ²=11.62，p=0.001）、收缩压≥160 mmHg（χ²=15.31，p<0.001）、舒张压≥110 mmHg（χ²=5.7，p=0.017）、全身性急性水肿（χ²=14.66，p<0.001）、血细胞比容<35%（χ²=11.16，p=0.001）、血清肌酐>100 μmol/L（χ²=13.46，p<0.001）、天冬氨酸转氨酶（AST）>70 IU/L（χ²=10.15，p=0.001）以及血小板减少（χ²=22.73，p<0.001）。此外，多因素分析中子痫的独立预测因素包括产前检查不足[比值比（OR），8.96[95%置信区间（CI）：3.9 - 20.5]，p<0.001]、收缩压≥160 mmHg（OR，3.130[95% CI：1.342 - 7.305]，p=0.008）、血小板计数<50,000的血小板减少（OR，13.106[95% CI：1.344 - 127.823]，p=0.027）、AST≥70 IU（OR，3.575[95% CI：1.313 - 9.736]，p=0.007）以及肝酶水平升高和血小板计数低（ELLP）综合征，这是HELLP综合征（H代表溶血）的一种不完全变体（OR，5.83[95% CI：2.43 - 13.9]，p<0.001）。
这项研究突出了该患者群体中的两个主要危险因素，即产前检查不足和ELLP综合征，这有助于早期识别发生子痫风险最高的患者并指导预防措施。
