Maternal outcomes according to mode of delivery in women with severe preeclampsia: a cohort study

Abstract

Objective: To determine the association between mode of delivery and maternal complications in patients with severe preeclampsia.

Methods: A prospective cohort study was conducted with 500 pregnant women with severe preeclampsia. The mode of delivery, vaginal or caesarean section, was considered the exposure, while the postpartum maternal complications and severe maternal morbidity were the outcomes. Logistic regression analysis was performed to determine the adjusted risk and 95% confidence intervals (95% CI) of maternal morbidity.

Results: Labour was spontaneous in 22.0% and induced in 28.2%, while 49.8% had an elective caesarean section. Ninety-five (67.4%) of the patients in whom labour was induced delivered vaginally. Total Caesarean rate was 68.2%. The risk of severe maternal morbidity was significantly greater in patients submitted to Caesarean section (54.0% versus 32.7%) irrespective of the presence of labour. Factors that remained associated with severe maternal morbidity following multivariate analysis were a diagnosis of HELLP syndrome after delivery (OR = 3.73; 95% CI: 1.55–9.88) and having a caesarean (OR = 1.91; 95% CI: 1.52–4.57).

Conclusions: Caesareans are often performed in patients with severe preeclampsia and are associated with significant postpartum maternal morbidity. Induction of labour should be considered a feasible option in these patients.

• Caesarean
• complications
• delivery
• labour
• obstetrics
• pre-eclampsia
• prognosis

Acknowledgements

The authors thank National Council for Scientific and Technological Development (CNPq) for the financial support.

Disclosure of interest

National Counsel of Technological and Scientific Development (CNPq), Brazil. Melania Amorim conceived the study, developed the initial protocol, analysed the data, jointly drafted the article and is guarantor. Leila Katz reviewed and amended the study protocol, contributed to enrolment of patients, interpreting data and writing the final version of the article. Amanda de Souza Barros and Tainara Sá Freire de Almeida participated in the development of the initial protocol, enrolled patients and collected data. Alex Sandro Rolland de Souza reviewed the study protocol and contributed to statistical analysis and writing the final version of the article. Anibal Faúndes reviewed the study protocol and the final version of the article. The study was approved by the institution’s Institutional Review Board under reference # 1199 on 26 June 2008.