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Hypertension in Pregnancy Volume 40, 2021 - Issue 4
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Research Article

Predictability of adverse outcomes in hypertensive disorders of pregnancy: a multicenter prospective cohort study

Daniela N. Vasqueza ICU, Sanatorio Anchorena, City of Buenos Aires, Argentina;b ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, ArgentinaCorrespondence[email protected]
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,
Andrea V. Das Nevesb ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, ArgentinaView further author information
,
Vanina M. Aphaloa ICU, Sanatorio Anchorena, City of Buenos Aires, ArgentinaView further author information
,
Laura Vidalc ICU, Hospital Pablo Soria, San Salvador De Jujuy, Jujuy, ArgentinaView further author information
,
Miriam Moseincod ICU, Sanatorio Otamendi, City of Buenos Aires, ArgentinaView further author information
,
Jorge Lapadulae ICU, Hospital Nacional Prof. Alejandro Posadas, Villa Sarmiento, Bs As, ArgentinaView further author information
,
Analía Santa-Mariaf ICU, Sanatorio Mitre, City of Buenos Aires, ArgentinaView further author information
,
Graciela Zakalikg ICU, Hospital Luis Lagomaggiore, City of Mendoza, Mendoza, ArgentinaView further author information
,
Raúl A. Gomezh ICU, Sanatorio De Los Arcos, City of Buenos Aires, ArgentinaView further author information
,
Mónica Capalboi ICU, Hospital Gral De Agudos José M.Penna, City of Buenos Aires, ArgentinaView further author information
,
Claudia Fernandezj ICU, Hospital De Agudos Ramón Madariaga, Posadas, Misiones, ArgentinaView further author information
,
Enrique Agüero-Villarealk ICU, Hospital Policlínico Regional Dr. Ramón Carrillo, City of Santiago Del Estero, Santiago Del Estero, ArgentinaView further author information
,
Santiago Vommarol ICU, Sanatorio Mater Dei, City of Buenos Aires, ArgentinaView further author information
,
Marcelo Morettim ICU, Hospital Naval, City of Buenos Aires, ArgentinaView further author information
,
Silvana B. Solin ICU, Sanatorio Julio Corzo, Rosario, Santa Fé, ArgentinaView further author information
,
Florencia Ballesteroo ICU, Hospital Británico, City of Buenos Aires, ArgentinaView further author information
,
Juan P. Sottilep ICU, Hospital Zonal Bariloche, Bariloche, Río Negro, ArgentinaView further author information
,
Viviana Chapierq ICU, Hospital Español De Mendoza, Godoy Cruz, Mendoza, ArgentinaView further author information
,
Carlos Lovesior ICU, Sanatorio Parque, Rosario, Santa Fé, ArgentinaView further author information
,
José Santoss ICU, Clínica Colón, Mar Del Plata, Bs As, ArgentinaView further author information
,
Fernando Bertolettit ICU, Sanatorio San Jorge, Usuhaia, Tierra Del Fuego, ArgentinaView further author information
,
Fernando A. Mosa ICU, Sanatorio Anchorena, City of Buenos Aires, ArgentinaView further author information
,
Alejandro Risso-Vazquezd ICU, Sanatorio Otamendi, City of Buenos Aires, ArgentinaView further author information
,
Mercedes Esteban-Chacone ICU, Hospital Nacional Prof. Alejandro Posadas, Villa Sarmiento, Bs As, ArgentinaView further author information
,
Santiago Illutovichg ICU, Hospital Luis Lagomaggiore, City of Mendoza, Mendoza, ArgentinaView further author information
,
Sebastián Chapelao ICU, Hospital Británico, City of Buenos Aires, ArgentinaView further author information
,
Cecilia I. Loudetb ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, ArgentinaView further author information
,
José L. Scapellatoa ICU, Sanatorio Anchorena, City of Buenos Aires, ArgentinaView further author information
,
Alfredo D. Intilea ICU, Sanatorio Anchorena, City of Buenos Aires, ArgentinaView further author information
&
Elisa Estenssorob ICU, Hospital Interzonal De Agudos Gral. San Martín, La Plata, Bs As, ArgentinaView further author information
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Pages 279-287 | Received 12 Jul 2021, Accepted 11 Sep 2021, Published online: 29 Sep 2021
 
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ABSTRACT

Objectives

To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP).

Methods

Multicenter, prospective, national cohort study.

Results

Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06–1.35]), gestational age (OR0.698[0.59–0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001–1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16–1.30), 0.76(0.59–1.02), and 1.1(0.98–1.2), respectively.

Conclusions

Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.

Abbreviations

HDP, hypertensive disorders of pregnancy; ICU, intensive care unit; APACHE II, Acute Physiology and Chronic Health Evaluation II; SOFA24, Sequential Organ Failure Assessment during the first 24 h; ARDS, acute respiratory distress syndrome; MODS, multiple-organ dysfunction syndrome; SBP, systolic blood pressure; DBP, diastolic blood pressure; GH, gestational hypertension; CH, chronic hypertension; HELLP, hemolysis, elevated liver enzymes and low platelets; CFR, case fatality rates; ICH, intracranial hemorrhage.

Acknowledgments

We are indebted to all patients who participated in this study with the aim of helping other women at risk and to Maria-Teresa Pérez who co-edited this manuscript.

Disclosure statement

The author(s) report no conflict of interest.

Additional information

Funding

The authors received no funding for the research.

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