Amin Bushra Z, Kern-Goldberger Adina R, Srinivas Sindhu K
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Am J Perinatol. 2024 May;41(S 01):e2047-e2050. doi: 10.1055/a-2097-1212. Epub 2023 May 22.
The objective of this study is to examine risk factors and adverse outcomes related to preeclampsia with severe features complicated by pulmonary edema.
This is a nested case-control study of all patients with preeclampsia with severe features who delivered in a tertiary, urban, academic medical center over a 1-year period. The primary exposure was pulmonary edema and the primary outcome was a composite of severe maternal morbidity (SMM), defined according to the Centers for Disease Control and Prevention and based on International Classification of Diseases, 10th revision, Clinical Modification codes. Secondary outcomes included postpartum length of stay, maternal intensive care unit admission, 30-day readmission, and discharge on antihypertensive medication. A multivariable logistic regression model adjusting for clinical characteristics related to the primary outcome was used to determine adjusted odds ratios (aOR) as measures of effect.
Of 340 patients with severe preeclampsia, there were seven cases of pulmonary edema (2.1%). Pulmonary edema was associated with lower parity, autoimmune disease, earlier gestational age at diagnosis of preeclampsia and at delivery, and cesarean section. Patients with pulmonary edema demonstrated increased odds of SMM (aOR: 10.11, 95% confidence interval [CI]: 2.13-47.90), extended postpartum length of stay (aOR: 32.56, 95% CI: 3.95-268.45), and intensive care unit admission (aOR: 102.85, 95% CI: 7.43-1422.92) compared with those without pulmonary edema.
Pulmonary edema is associated with adverse maternal outcomes among patients with severe preeclampsia, and is more likely to affect patients who are nulliparous, have an autoimmune disease, and are diagnosed preterm.
· Pulmonary edema increases odds of severe maternal morbidity in preeclamptics.. · Pulmonary edema prolongs postpartum and intensive care unit stay in preeclamptics.. · Risk factors for pulmonary edema include nulliparity and autoimmune disease.. · Earlier diagnosis of severe preeclampsia increases risk of pulmonary edema..
本研究旨在探讨重度子痫前期合并肺水肿的危险因素及不良结局。
这是一项巢式病例对照研究，研究对象为在一所城市三级学术医疗中心分娩的所有重度子痫前期患者，研究周期为1年。主要暴露因素为肺水肿，主要结局为严重孕产妇发病率（SMM）的复合指标，该指标根据美国疾病控制与预防中心的定义，基于《国际疾病分类》第10次修订版临床修订编码确定。次要结局包括产后住院时间、入住产妇重症监护病房、30天再入院以及出院时服用降压药物情况。采用多变量逻辑回归模型，对与主要结局相关的临床特征进行调整，以确定调整后的优势比（aOR）作为效应指标。
在340例重度子痫前期患者中，有7例发生肺水肿（2.1%）。肺水肿与低产次、自身免疫性疾病、子痫前期诊断时及分娩时孕周较早以及剖宫产有关。与无肺水肿的患者相比，发生肺水肿的患者出现严重孕产妇发病率的几率增加（aOR：10.11，95%置信区间[CI]：2.13 - 47.90），产后住院时间延长（aOR：32.56，95%CI：3.95 - 268.45），入住重症监护病房的几率增加（aOR：102.85，95%CI：7.43 - 1422.92）。
肺水肿与重度子痫前期患者的不良孕产妇结局相关，且更易影响初产妇、患有自身免疫性疾病以及早产诊断的患者。
· 肺水肿增加子痫前期患者发生严重孕产妇发病率的几率。· 肺水肿延长子痫前期患者产后及重症监护病房住院时间。· 肺水肿的危险因素包括初产和自身免疫性疾病。· 重度子痫前期的早期诊断增加肺水肿风险。
