Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil.
Stricto Sensu Postgraduate Program, Instituto de Medicina Integral Prof. Fernando Figueira , Recife, Pernambuco, Brazil.
Medicine (Baltimore). 2021 Sep 24;100(38):e27313. doi: 10.1097/MD.0000000000027313.
To describe the clinical profile, management, maternal outcomes and factors associated with severe maternal outcome (SMO) in patients admitted for eclampsia.A retrospective cohort study was carried out. All women admitted to the Obstetric Intensive Care Unit (ICU) at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast of Brazil, from April 2012 to December 2019 were considered for inclusion and patients with the diagnosis of eclampsia were selected. Patients who, after reviewing their medical records, did not present a diagnosis of eclampsia were excluded from the study. Severe maternal outcome (SMO) was defined as all cases of near miss maternal mortality (MNM) plus all maternal deaths during the study period. The Risk Ratio (RR) and its 95% confidence interval (95% CI) were calculated as a measure of the relative risk. Multiple logistic regression analysis was performed to control confounding variables. The institute's internal review board and the board waived the need of the informed consent.Among 284 patients with eclampsia admitted during the study period, 67 were classified as SMO (23.6%), 63 of whom had MNM (22.2%) and 5 died (1.8%). In the bivariate analysis, the following factors were associated with SMO: age 19 years or less (RR = 0.57 95% CI 0.37-0.89, P = .012), age 35 years or more (RR = 199 95% CI 1.18-3.34, P = .019), the presence of associated complications such as acute kidney injury (RR = 3.85 95% CI 2.69-5.51, P < .001), HELLP syndrome (RR = 1.81 95% CI 1.20-2.75, P = .005), puerperal hemorrhage (PPH) (RR = 2.15 95% CI 1.36-3.40, P = .003) and acute pulmonary edema (RR = 2.78 95% CI 1.55-4.96, P = .008). After hierarchical multiple logistic regression analysis, the factors that persisted associated with SMO were age less than or equal to 19 years (ORa = 0.46) and having had PPH (ORa = 3.33).Younger age was a protective factor for developing SMO, while those with PPH are more likely to have SMO.
描述子痫患者的临床特征、治疗方法、母婴结局以及与严重产妇结局（SMO）相关的因素。
这是一项回顾性队列研究。纳入 2012 年 4 月至 2019 年 12 月期间在巴西东北部累西腓市费尔南多·菲格雷多综合医学研究所（IMIP）产科重症监护病房（ICU）住院的所有子痫患者，并对其进行了研究。将在回顾病历后未被诊断为子痫的患者排除在研究之外。严重产妇结局（SMO）定义为所有接近产妇死亡的病例（MNM）加上研究期间所有产妇死亡。风险比（RR）及其 95%置信区间（95%CI）用于衡量相对风险。采用多因素逻辑回归分析来控制混杂因素。机构内部审查委员会和委员会豁免了知情同意的要求。
在研究期间，共 284 例子痫患者入院，其中 67 例被归类为 SMO（23.6%），其中 63 例为 MNM（22.2%），5 例死亡（1.8%）。在单因素分析中，以下因素与 SMO 相关：年龄 19 岁或以下（RR=0.57，95%CI 0.37-0.89，P=0.012），年龄 35 岁或以上（RR=199，95%CI 1.18-3.34，P=0.019），存在急性肾损伤（RR=3.85，95%CI 2.69-5.51，P<0.001）、HELLP 综合征（RR=1.81，95%CI 1.20-2.75，P=0.005）、产后出血（PPH）（RR=2.15，95%CI 1.36-3.40，P=0.003）和急性肺水肿（RR=2.78，95%CI 1.55-4.96，P=0.008）。经过分层多因素逻辑回归分析，与 SMO 相关的持续因素是年龄小于或等于 19 岁（ORa=0.46）和 PPH（ORa=3.33）。年龄较小是发生 SMO 的保护因素，而发生 PPH 的患者更有可能发生 SMO。
