Severe preeclampsia and its impact on maternal mortality risk

• Nariman R. Akhmadeev
• Victor E. Radzinsky
• Ildar F. Fatkullin

Abstract

Severe preeclampsia (PE) is one of the leading causes of maternal mortality in the world and is included in the list of critical obstetric conditions (COC) monitored in the Russian Federation. There is conflicting information regarding the determination of the risk of adverse outcome in patients with severe PE.

Aim – to determine the influence of severe PE on maternal mortality (MM) and the possibility of reducing it.

Material and methods. An analysis was carried out of cases included in the COC Register of the module “Obstetrics and Neonatology” of the Vertically Integrated Medical Information Systems of the Ministry of Health of Russia in the period from 01/01/2022 to 12/31/2023 in the Volga Federal District, information from territorial health authorities of the constituent entities of the Volga Federal District for MM cases for the period from 01/01/2022 to 12/31/2023. The analyzed indicators were: the leading criterion for COC upon admission: “severe PE”, “eclampsia”, “jaundice in preeclampsia”; the presence of a concomitant diagnosis of severe PE with other leading criteria for COC; groups of obstetric hospitals.

Results. During this period, 3029 cases of COC and 52 cases of MM were registered. PE was indicated as the cause of death in 6 (11.5%) women, including 3 (50.0%) HELLP syndromes, 2 (33.3%) eclampsia and 1 (16.6%) severe PE. Also, the diagnosis of “severe PE” was in 7 (13.5%) women who died due to other causes. The leading criteria for COC upon admission, were severe PE – 1348 (44.5%) women, eclampsia – 60 (2.0%) and jaundice in preeclampsia – 1 (0.02%). The odds of death in the “severe PE” group were 13.461 times lower compared to patients with other leading criteria (OR=0.074; 95% CI 0.023–0.239; p<0.001). In general, the odds of death in women with PE was 4.717 times lower compared to the group without this diagnosis (OR=0.212; 95% CI 0.103–0.436; p<0.001).

Discussion. As a result of the study, counterintuitive analytical data were identified that indicate a reduction in the risk of maternal death if a woman is diagnosed with “severe PE.” The presence of regulated approaches to the management of patients with severe PE increases the chances of improving maternal outcomes. At the same time, there is an incomprehensible desire to “reduce” the number of PE, an unmotivated substitution of the diagnosis of PE with the previously non-existent “chronic arterial hypertension” with an inadequate choice of tactics. All cases of MM due to PE, as the main cause of death, occurred either during progression to the thrombotic microangiopathy (HELLP syndrome) or central nervous system damage (eclampsia). In all cases, there were defects and violatons led to delayed diagnosis of the condition and underestimation of the severity of PE in the early stages. The main organizational in cases of MM associated with PE was the incorrect routing of patients to a hospital of group 1 or 2, if there were indications for hospitalization at tertiary hospital.

Conclusion. An undoubted reserve for reducing MM is timely prevention of the development of extremely severe forms of PE (HELLP syndrome and eclampsia), adequate tactics for managing severe PE in patients with extragenital diseases, and routing patients with PE to group 3A obstetric hospitals.

Keywords: severe preeclampsia; maternal mortality; great obstetric syndromes

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