Accurately Predicting the Risk of Serious Maternal Morbidity in Preterm Preeclampsia
Can It Be Done?
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
See related article, pp 659–665
The advent of antenatal care during the early 20th century and advances in obstetric management of pregnancies complicated by preeclampsia has drastically improved outcomes for women and their babies. Yet, even with advances, hypertensive disorders in pregnancy remain a leading cause of direct maternal mortality. Globally, hypertensive disorders of pregnancy are responsible for 10% to 22% of maternal deaths.1 The developing world shoulders most of this terrible burden: a staggering 99% of all maternal deaths.2 Preeclampsia is also a major cause of maternal morbidity.3
Encouragingly, aspirin use from early pregnancy can prevent preeclampsia developing, particularly early onset disease, for a significant number of women.4 However, for those who do develop preeclampsia, progressive end-organ dysfunction is the natural course while women remain undelivered. But preeclampsia is also highly heterogeneous; some women remain undelivered for weeks with stable disease, while others deteriorate rapidly and develop severe life-threatening features. Currently, when women present with preeclampsia, clinicians have no way to predict who will remain stable and who will spiral rapidly toward life-threatening organ injury. Developing a prediction tool would be of immense use for clinicians juggling patient care and allocating precious hospital resources. In this edition of Hypertension, Ukah et al5 assess the use of such a prediction tool in women with early-onset preeclampsia.
Clinical tools developed to predict adverse outcomes are widely used in other clinical specialties—for example, the APACHE II scoring system (Acute Physiology and Chronic Health Evaluation II) to estimate a patient’s mortality risk on admission to an intensive care unit, …