by laura (5139 Posts), Fri Mar 02, 2007 01:26 pm
Here's our first response, I'll make sure they're posted in ATExperts when they're all in:
It depends - of course.
The probability of dying from preeclampsia in the US is very small. If one chose an overall maternal mortality ration of 8/100,000 in the US, then the ratio for preeclampsia is probably no more than 25% of that or 2/100,000. This could approach the risk of a daily activity of riding a bicycle to work for 9 months. With a history of prior preeclampsia, the risk will be raised by an increased incidence of disease but probably lowered by increased awareness and surveillance. When I counsel a woman about attempting a pregnancy after an episode of severe preeclampsia, maternal mortality is not really a consideration.
Now, all of that said, we have a list (or more like a corporate memory) of numbers of cases where a woman has died with preeclampsia in the US. I don't think there are any that entered the pregnancy in the care of a system that had expertise. In a study by Jim MArtin on HELLP and mortality, a large number of deaths (80%) were associated with avoidable delay. (see below)
In the developing world - an entirely different question if we are asking about our global social concern -conscience. I just returned from India where maternal mortality from preeclampsia is "routine."
Am J Obstet Gynecol. 1999 Oct;181(4):924-8.
Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.
Isler CM, Rinehart BK, Terrone DA, Martin RW, Magann EF, Martin JN Jr.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA.
OBJECTIVE: The aim of this study was to determine factors contributing to deaths among women with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. STUDY DESIGN: Information from multiple sources was scrutinized to distinguish and profile maternal deaths associated with HELLP syndrome. RESULTS: Information was available regarding 54 maternal deaths. According to HELLP syndrome classification 60.0% had class 1 disease, 35.6% had class 2 disease, and 4.4% had class 3 disease. Events associated with maternal deaths included cerebral hemorrhage (45%), cardiopulmonary arrest (40%), disseminated intravascular coagulopathy (39%), adult respiratory distress syndrome (28%), renal failure (28%), sepsis (23%), hepatic hemorrhage (20%), and hypoxic ischemic encephalopathy (16%). Delay in diagnosis of HELLP syndrome was implicated in 22 of 43 patients' deaths (51.1%). CONCLUSIONS: It appears that (1) most maternal deaths occurred among women with class 1 HELLP syndrome, (2) delay in diagnosis was associated with mortal consequences, and (3) hemorrhage in the hepatic or central nervous system or vascular insult to the cardiopulmonary or renal system were associated with increased mortality risk.