Veenstra, M.K. (2021) Early severe preeclampsia, practice variations and outcomes in Dutch centres. thesis, Medicine.
Full text available on request.Abstract
Background: There is only little evidence regarding the best intervention strategy regarding early (before the 34th week of gestation), severe preeclampsia (PE). The aim of this study was protocol evaluation and retrospective patient file analysis to gain insight in factors that influence the timing of delivery, and the effects on the mother and neonate in three Dutch centres. Methods: A protocol review of the protocols regarding PE of the ten Dutch perinatal centres was performed. Subsequently, data from patients who were admitted between 2012 and 2019 at the Amsterdam Medical Centre (AMC), Erasmus Medical Centre and University Medical Centre Groningen (UMCG) with severe PE and a gestational age between 235/7 and 315/7 was collected. The primary outcomes were days between admission and delivery and adverse maternal, fetal and neonatal outcomes. Findings: In total 147 patients with singleton pregnancies were included. The hospitals included had significant differences in days between admission and delivery (10 in the AMC versus 4 in the Erasmus MC and 3 in the UMCG), although this policy was not observed in the protocols. When the gestational age at admission increased, the chances of prolongation decreased (β = -0.163 [95% CI: -0.174 to 0.000] p = 0.049). The chances of adverse neonatal outcomes decreased when the gestational age at admission and birth weight increased (OR’s respectively 0.953 and 0.996, p values 0.001 and <0.001). There was no relation between the days of prolongation and the chances of adverse maternal and neonatal outcomes. Conclusion: There is no direct link between the days of pregnancy prolongation and maternal, fetal and neonatal outcomes. It was observed that a low gestational age at admission and birth weight can be predictors for adverse neonatal outcomes. This should be taken into account in the decision for intervention. However, more research in this population is necessary. Keywords: Early severe pre-eclampsia, maternal, fetal and neonatal outcome, intervention, temporising treatment
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Gordijn, dr. S.J. and Postma, dr. I.R. |
| Faculty: | Medical Sciences |
| Date Deposited: | 04 Jan 2022 10:19 |
| Last Modified: | 04 Jan 2022 10:19 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2931 |
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