Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.
Centre d'Etudes Périnatales Océan Indien Centre Hospitalier Universitaire Sud-Réunion, Saint-Pierre cedex, Réunion Island.
J Matern Fetal Neonatal Med. 2022 Nov;35(22):4285-4290. doi: 10.1080/14767058.2020.1849106. Epub 2020 Nov 18.
Preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of our study was to study risk factors and complications associated with severe preeclampsia requiring intensive care unit (ICU) admission.
Retrospective comparative study over a period from 1st of January 2015 to 1st of January 2019 in the University's maternity unit of South Reunion (Indian Ocean). Our sampling included all preeclamptic patients who delivered in the Southern part of the island. Patients admitted to intensive care unit (ICU) and those who remained in the maternity unit (controls) were reviewed.
Out of 482 preeclampsia cases, 94 women (19.5%) needed a transfer in ICU, of which only 21 (4.3%) needed invasive intensive care. Mean length of stay was 2.4 ± 2.1 days. ICU admission was associated with HELLP syndrome (OR 8.5 [4.9-14.9], <.001), severe post-partum hemorrhage (OR 5.86 [1.29-26.70], =.01) and early onset of preeclampsia (<34 weeks gestation), 2.97 [1.9-4.7], <.001), leading to higher rate of C-section (OR 2.83 [1.67-4.78], <.001). There were three patients with a history of eclampsia and no case of maternal death was reported. Fetal prognosis was much poorer in maternal ICU admissions than in controls, with outcomes including lower birth weight (1776 vs. 2304 g, <.001) and higher perinatal morbidity (infant respiratory distress syndrome 3.70 [1.94-7.05], <.001) and mortality (<.001).
Women needing invasive ICU represented 4.3% of preeclampsia cases. This experience is of interest for lower resource settings such as in countries like Madagascar where very intensive ICU means are very poor, but simpler ICU surveillance is possible. Fetal prognosis was poor though no maternal death was reported. Thus, a multidisciplinary approach of patients with preeclampsia should be encouraged; admission into ICU should be facilitated, as soon as any sign of severity and complications appears.
子痫前期是导致孕产妇和胎儿发病率和死亡率的主要原因之一。本研究的目的是研究与需要重症监护病房（ICU）入院的重度子痫前期相关的危险因素和并发症。
这是 2015 年 1 月 1 日至 2019 年 1 月 1 日在留尼汪岛南部大学妇产单位进行的回顾性对比研究。我们的抽样包括在该岛南部分娩的所有子痫前期患者。对入住重症监护病房（ICU）的患者和留在妇产科病房（对照组）的患者进行了回顾性分析。
在 482 例子痫前期病例中，94 例（19.5%）需要转入 ICU，其中仅有 21 例（4.3%）需要侵入性重症监护。平均住院时间为 2.4±2.1 天。ICU 入院与 HELLP 综合征（OR 8.5[4.9-14.9]，<0.001）、严重产后出血（OR 5.86[1.29-26.70]，=0.01）和早发型子痫前期（<34 周妊娠）（OR 2.97[1.9-4.7]，<0.001）相关，导致剖宫产率更高（OR 2.83[1.67-4.78]，<0.001）。有 3 例有子痫病史，无孕产妇死亡病例报告。与对照组相比，在 ICU 住院的产妇胎儿预后更差，结局包括低出生体重（1776 与 2304g，<0.001）和围产期发病率更高（新生儿呼吸窘迫综合征 3.70[1.94-7.05]，<0.001）和死亡率（<0.001）。
需要侵入性 ICU 的子痫前期患者占 4.3%。对于像马达加斯加这样资源匮乏的国家来说，这种经验很有意义，因为那里 ICU 设备非常简陋，但可以进行更简单的 ICU 监测。尽管没有孕产妇死亡报告，但胎儿预后仍很差。因此，应该鼓励对子痫前期患者进行多学科治疗；一旦出现任何严重程度和并发症的迹象，就应促进 ICU 入院。
