Abstract
Background
Preeclampsia is a multi-systemic, multi-organ dysfunction associated with increased maternal and perinatal complications. The presence of maternal ascites, a manifestation of endothelial dysfunction and increased capillary permeability, is shown to be associated with adverse outcomes. We aim to investigate the impact of maternal ascites on pregnancy outcome in women with severe preeclampsia.
Methods
A matched cohort study was conducted in a tertiary care teaching hospital in South India between March 2014 and March 2015. One hundred and twenty-one severe preeclamptic women with ascites formed the study cohort while age-, parity-, and gestational age-matched group of 121 severe preeclamptic women without ascites formed the control. Primary outcome was the composite maternal adverse outcome defined as the development of any of eclampsia, pulmonary edema, renal failure, or disseminated intravascular coagulation (DIC). Secondary outcome was the composite perinatal outcome defined as the occurrence of any of still birth, hypoxic ischemic encephalopathy or early neonatal death.
Results
Four maternal deaths occurred in the study group. The rates of pregnancies with composite maternal adverse outcome [42 vs 9% RR 4.6 (95% CI 2.5–8.4)] and composite perinatal adverse outcome [36 vs 17% RR 2.1, (95% CI 1.3–3.3)] were significantly more in ascites group than in control group. After adjusting for other confounding variables, ascites was independently associated with adverse maternal events [adjusted OR 16.40 (95% CI 2.88–93.31)] but not adverse perinatal outcome.
Conclusion
In women with severe preeclampsia, maternal ascites is an independent risk factor for adverse maternal outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Duley L (2009) The global impact of pre-eclampsia and eclampsia. Semin Perinatol 33:130–137
Mignini LE, Villar J, Khan KS (2006) Mapping the theories of preeclampsia: the need for systematic reviews of mechanisms of the disease. Am J Obstet Gynecol 194:317–321
Merviel P, Carbillon L, Challier JC, Rabreau M, Beaufils M, Uzan S (2004) Pathophysiology of preeclampsia: links with implantation disorders. Eur J Obstet Gynecol Reprod Biol 115(2):134–147
American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy (2013) Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Obstet Gynecol 122(5):1122–1131
Levi M, Toh CH, Thachil J, Watson HG (2009) Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol 145:24–33
Sarnat HB, Sarnat MS (1976) Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol 33:695–706
Figueras F, Gratacós E (2014) Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther 36:86–98
Deruelle P, Coudoux E, Ego A, Houfflin-Debarge V, Codaccioni X, Subtil D (2006) Risk factors for post-partum complications occurring after preeclampsia and HELLP syndrome. A study in 453 consecutive pregnancies. Eur J Obstet Gynecol Reprod Biol 2006(125):59–65
Woods JB, Blake PG, Perry KG Jr, Magann EF, Martin RW, Martin JN Jr (1992) Ascites: a portent of cardiopulmonary complications in the preeclamptic patient with the syndrome of hemolysis elevated liver enzymes and low platelets. Obstet Gynecol 80:87–91
Woo JS, Liang ST, Wong VT (1982) Ultrasonic detection of maternal ascites in patients with severe preeclampsia. Aust N Z J Obstet Gynaecol 22:237–239
Cong KJ, Wang TT (1994) Complications of ascites in pregnancy induced hypertension. Zhonghua Fu Chan Ke Za Zhi. 29(1):7–9
Ashmore J, Attapattu JA (1998) Massive ascites and bilateral hydrothorax complicating severe pre-eclampsia. Ceylon Med J 43:235–237
Foreman CS Jr (1989) Massive ascites as a complication of severe pre-eclampsia. A case report. J Reprod Med 34:307–310
Author contributions
AK, Prof SSR, and YSJ conceived the study. All authors (AK, YSJ, MK, DKM, VP, and SR) contributed to the design. YSJ carried out the data collection and guarantees data integrity. AK performed statistical analyses. AK and MK critically reviewed the analysis. All authors (AK, YSJ, MK, DKM, VP, and SR) contributed to the drafting, revising, and finalization of the manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no conflicts of interest.
Ethical approval
All procedures performed in this study were done with the ethical standards set by the Institute Scientific Advisory and Ethical committee (Human Studies), in accordance with the 1964 Helsinki declaration and its later amendments. Study was approved by the Institute Ethics committee (Human Studies), JIPMER, Pondicherry, India (JIP/IEC/SC/2014/3/557). Informed consent was obtained from all women participated in the study.
Funding
None.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Suriya, J.Y., Keepanasseril, A., Manikandan, K. et al. Maternal ascites an independent prognostic factor in severe preeclampsia: a matched cohort study. Arch Gynecol Obstet 296, 63–68 (2017). https://doi.org/10.1007/s00404-017-4407-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-017-4407-8