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Re: Any statistics on complications?

Posted: Mon Aug 29, 2011 02:42 pm
by veronica44
Thank you so much Caryn! Off to read...

Re: Any statistics on complications?

Posted: Mon Aug 29, 2011 09:49 am
by caryn
You know, I should probably create something like this in a nice graphic. Because you're quite right; they report it as "women with preeclampsia have 1.2 times the risk of whatever" but this is no help, since you don't know what the original risk was.

Expectant management of preeclamptics aims to *avoid* complications by timing delivery carefully. That makes it really difficult to report this accurately, since the sort of medical care we get changes our complication rate. The rate of cardiomyopathy in Sudan and the rate of cardiomyopathy at the top clinic in your state are going to be very, very different. That's why we so strongly encourage working with an MFM who's used to dealing with these conditions proactively. Realistically, if you've got care from a good provider, the risk of something awful like death to you is far less than the risk you incur by driving to the store in your car, and the milder complications are acute and transient and timing delivery carefully can almost eliminate them.

I have found a few links for you. I particularly like the HYPITAT trial for this.
Of women who were randomised, 117 (31%) allocated to induction of labour developed poor maternal outcome compared with 166 (44%) allocated to expectant monitoring (relative risk 0.71, 95% CI 0.59-0.86, p<0.0001). No cases of maternal or neonatal death or eclampsia were recorded.

As far as I know, this is the latest big trial in a First World country that would have measured these rates, and it's an example of the power of timed delivery. "Poor maternal outcome" is just lumped together in the abstract, but they were measuring maternal mortality, maternal morbidity (eclampsia, HELLP syndrome, pulmonary oedema, thromboembolic disease, and placental abruption), progression to severe hypertension or proteinuria, and major post-partum haemorrhage (>1000 mL blood loss). Obviously it's a lot more likely that your pressures would rise to one of either 160/100 once than it is that you'd die. IIRC the actual numbers are in the full-text, which is somewhere in my files; I'll have to dig a bit for it and make up a graphic!

For neonatal outcomes:
Compared with women who did not experience hypertension during pregnancy, women with preeclampsia had increased risks of having children who were preterm (odds ratio = 5.89, 95% confidence interval: 2.63, 13.14), had a low birth weight (odds ratio = 8.94, 95% confidence interval: 6.19, 12.90), or were small for their gestational age (odds ratio = 5.03, 95% confidence interval: 3.31, 7.62).

and from hospital case studies:
The global complications rate was 14% (9% heart failure, 5% acute renal failure and 2% coagulopathy). Maternal mortality was 1.5% (4 patients), and was associated with non-nulliparous status, the presence of complications, and toast > 71mg/dl. <-- a hospital in Latin America
Maternal mortality rate was 0.19% (8/4107), and the specific mortality rate was 11.26/100 000. The proportion of severe complications of hypertensive disorder complicating pregnancy from high to low was as follows: placental abruption 1.68% (69/4107), DIC 1.36% (56/4107), hypertensive disorder complicating pregnancy induced cardiopathy (induced cardiopathy) 1.05% (43/4107), renal failure 0.97% (40/4107), cerebrovascular accident 0.58% (24/4107), and hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome 0.51% (21/4107). Mortality caused by severe complications of hypertensive disorder complicating pregnancy were as follows: cerebrovascular accident 17% (4/24), HELLP syndrome 10% (2/21), DIC 5% (3/56) and induced cardiopathy 2% (1/43). <--several hospitals in Guangzhou, China

Hope that helps a little...

Re: Any statistics on complications?

Posted: Sat Aug 27, 2011 09:05 pm
by veronica44
Just to clarify - I am looking for statistics presented like this: X% of women with preeclampsia develop this complication.
I'm seeing a lot of statistics for total pregnancies (with or without PE) or for the entire population, and I am finding those hard to understand.

Any statistics on complications?

Posted: Sat Aug 27, 2011 09:00 pm
by veronica44
We're close to the time we decided on to try to get pregnant again, and I am so scared of another PE pregnancy. My husband asked my why I am so scared if our last pregnancy outcome was relatively positive (delivery at 38 weeks, no NICU time, my BP never went down and so have been on meds since then, but otherwise no major complications). He was interested in seeing the statistics for serious complications in preeclamptic pregnancies.
I was wondering if anybody could direct me to some literature describing statistics about occurrence of serious complications in women with preeclampsia. Such as maternal and fetal mortality, cardiomyopathy, liver failure, eclampsia. Any others I might not be aware of. Or just a summary of these statistics. Maybe a previous discussion on the forum?

Thanks in advance.