Pre-gestive and gestational background of near miss development and mother's death, due to pre-clampsia

• Anton S. Olenev
• Vladislavа A. Novikovа
• Igor N. Kostin
• Victor E. Radzinsky

Abstract

The aim of the study - differentiation of anamnestic, pregestational and gestational factors of high risk of life-threatening conditions (near miss and maternal mortality) caused by рreclampsia (РЕ).

Material and methods. A retrospective multicenter study was conducted. Confidentially analyzed 18 130 histories of patients with severe preeclampsia (PE), delivery in 2013-2018. Included are 27 healthcare institutions in Moscow. 100 histories of childbirth, complicated by the state near miss (Near miss group), 22 - resulting in maternal mortality (MM group) were selected.

Results and discussion. The increased risk of MM compared with near miss is associated with social and non-obstetric factors: lack of employment (OR=2.79; 95% CI 1.07-7.29), unmarried status (OR=14.41; 95% CI 2.58-80.39), diseases of the urinary system (OR=3.64; 95% CI 1.33-9.92), organs of the gastrointestinal tract (OR=4.61; 95% CI 1.26-16.81) excess weight (OR=5.59 1.46-21.4), obesity (OR=18.38; 95% CI 3,41-99.12). A missed opportunity to prevent risks of MM in the development of severe PE is the later 1^st appearance in the Women's counseling (p<0.001), turnout at 13 weeks and later (χ²=23.148, p<0.001). Gestational hypertension in 9.09% of patients in the MM group was detected in the first trimester of pregnancy (up to 160/90 mm Hg), in 22.73% in the second trimester (up to 200/110 mm Hg). In the MM group in the second trimester, the frequency of gestational pyelonephritis (RR=13.64; 95% CI 1.49-125) and iron deficiency anemia (IDA) (RR=6.06; 95% CI 1.46-25,18) was significantly higher. The gestational age for the diagnosis of severe PE covered a range of 24 to 40 (32.64+4.23) weeks. Early onset of PE was in 41% of patients of the Near miss group and 50% of the MS group (p=0.44). Intergroup differences in the proportion of women with a gestational age corresponding to very early, early, premature, late preterm births and full-term pregnancies have not been established (p>0.05).

Conclusion. Presented the significance of non-gestational (including social) and early non-obstetric antenatal factors in the risks of MM due to PE. The need for pregravid counseling for high-risk patients with PE has been proved, requiring highly qualified specialists (nephrologist, gastroenterologist, cardiologist, endocrinologist, etc.) on issues of diagnosis and correction of disorders. Normalization of weight to the target values determined by the obstetrician-gynecologist and endocrinologist is a measure not only of reducing maternal morbidity, but also of preventing MM. IDA or pyelonephritis detected from the second trimester of pregnancy should be considered as a threat to MM in the development of severe PE.

Keywords:preeclampsia, life-threatening conditions, near miss, maternal mortality, obesity, gestational pyelonephritis, iron deficiency anemia, gestational hypertension

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