Analysis of maternal morbidity and mortality among patients admitted to Obstetric Intensive Care with severe preeclampsia, eclampsia or HELLP syndrome

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Gómez Tello, J. Álvarez Rodríguez, A. Núñez Reiz, J.A. González Sánchez, A. Hernández Abadía de Barbará, M. Martínez Fresneda, P. Morrondo Valdeolmillos, J.M. Nicolás Arfelis, I. Pujol Varela, M. Calvete Chicharro" "autores" => array:13 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Gómez Tello" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Álvarez Rodríguez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Núñez Reiz" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "González Sánchez" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Hernández Abadía de Barbará" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Martínez Fresneda" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Morrondo Valdeolmillos" ] 7 => array:2 [ "nombre" => "J.M." "apellidos" => "Nicolás Arfelis" ] 8 => array:2 [ "nombre" => "I." "apellidos" => "Pujol Varela" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Calvete Chicharro" ] 10 => array:1 [ "colaborador" => "Grupo de Internet y Tecnologías de la Información y la Comunicación" ] 11 => array:1 [ "colaborador" => "Grupo de Planificación, Organización y Gestión" ] 12 => array:1 [ "colaborador" => "Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC)" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572711000543?idApp=WMIE" "url" => "/21735727/0000003500000008/v1_201212101030/S2173572711000543/v1_201212101030/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S217357271100049X" "issn" => "21735727" "doi" => "10.1016/j.medine.2011.11.003" "estado" => "S300" "fechaPublicacion" => "2011-11-01" "aid" => "287" "copyright" => "Elsevier España, S.L. and SEMICYUC" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Intensiva. 2011;35:470-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3052 "formatos" => array:3 [ "EPUB" => 152 "HTML" => 2250 "PDF" => 650 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Noninvasive mechanical ventilation in severe pneumonia due to H1N1 virus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "470" "paginaFinal" => "477" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilización de la ventilación mecánica no invasiva en neumonía grave por virus H1N1" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1390 "Ancho" => 1609 "Tamanyo" => 85527 ] ] "descripcion" => array:1 [ "en" => "Evolution of respiratory frequency during ventilatory support. Box plot with median and interquartile range." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Belenguer-Muncharaz, R. Reig-Valero, S. Altaba-Tena, P. Casero-Roig, A. Ferrándiz-Sellés" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Belenguer-Muncharaz" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Reig-Valero" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Altaba-Tena" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Casero-Roig" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Ferrándiz-Sellés" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357271100049X?idApp=WMIE" "url" => "/21735727/0000003500000008/v1_201212101030/S217357271100049X/v1_201212101030/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Analysis of maternal morbidity and mortality among patients admitted to Obstetric Intensive Care with severe preeclampsia, eclampsia or HELLP syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "478" "paginaFinal" => "483" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Curiel-Balsera, M.Á. Prieto-Palomino, J. Muñoz-Bono, M.J. Ruiz de Elvira, J.L. Galeas, G. Quesada García" "autores" => array:6 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Curiel-Balsera" "email" => array:1 [ 0 => "emiliouci@telefonica.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.Á." "apellidos" => "Prieto-Palomino" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Muñoz-Bono" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Ruiz de Elvira" ] 4 => array:2 [ "nombre" => "J.L." "apellidos" => "Galeas" ] 5 => array:2 [ "nombre" => "G." "apellidos" => "Quesada García" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Cuidados Intensivos Maternal, Hospital Regional Universitario Carlos Haya, Málaga, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la morbimortalidad materna de las pacientes con preeclampsia grave, eclampsia y síndrome HELLP que ingresan en una Unidad de Cuidados Intensivos gineco-obstétrica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 919 "Ancho" => 1628 "Tamanyo" => 80937 ] ] "descripcion" => array:1 [ "en" => "Complications according to the diagnosis upon admission." ] ] ] "textoCompleto" => "IntroductionPreeclampsia, a relatively common hypertensive disorder during pregnancy, manifests progressively and often gives rise to serious maternal and perinatal complications. While the etiology of preeclampsia is not clear, it is characterized by vasospasm and endothelial activation, with hypertension and proteinuria, after week 20 of pregnancy.The incidence of preeclampsia is variable, since many studies have used estimations based only on hospital samples—a situation that could explain the relatively frequently reported figure of up to 5–10%, depending on the healthcare levels of the hospitals in which the studies are made. It has been estimated that about 7% of all pregnant women develop preeclampsia,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> though the percentage could be higher in less favorable socioeconomic settings, and in countries with a higher prevalence of cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Although few estimations have been made in Spain, the existing data point to an incidence of 1–2%.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Five percent of all cases of preeclampsia in turn ultimately progress toward eclampsia,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> and in up to 19% of the cases the condition can manifest as HELLP syndrome, which is associated to increased morbidity–mortality.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>The adverse maternal consequences in preeclampsia are fundamentally attributable to dysfunction of the central nervous system, liver or kidneys (hemorrhagic stroke, liver rupture or acute renal failure), and to bleeding associated to thrombocytopenia. Preeclampsia–eclampsia is one of the three most common causes of mortality in pregnant women, together with thromboembolic disease and postpartum hemorrhage.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>The criteria of severe preeclampsia were established by the Spanish Society of Gynecology and Obstetrics (Sociedad Española de Ginecologia y Obstetricia) in 2006, and refer to a subgroup of patients with increased maternal-fetal mortality and more frequent management in intensive care units (ICUs).<a class="elsevierStyleCrossRef" href="#bib0035">7</a>The present study describes the epidemiology and risk and evolutive factors among patients with severe preeclampsia, eclampsia and HELLP syndrome.Material and methodsA prospective observational study has been made of all the patients admitted to the maternal intensive care unit (ICU) of the Maternal-Children's Hospital pertaining to the Carlos Haya Hospital Complex (Málaga, Spain) due to severe preeclampsia, eclampsia or HELLP syndrome, between January 1999 and September 2008.The Maternal-Children's Hospital serves 50% of the population of the city of Málaga, and is the only public hospital in the province equipped with a neonatal ICU. As a result, it is the reference center for patients with severe preeclampsia, eclampsia or HELLP syndrome in cases of early gestational age. The mentioned ICU is a specific, 8-bed gynecological-obstetric unit pertaining to the Carlos Haya Regional University Hospital—a third-level center with a total of 55 intensive care beds.Severe preeclampsia is defined by the presence of systolic blood pressure (SBP) ≥140mmHg or diastolic blood pressure (DBP) ≥90mmHg as determined by two or more measurements spaced at least 6h apart, together with proteinuria (≥300mg in 24h urine), and some of the severity criteria indicated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Eclampsia in turn is established when preeclampsia is accompanied by seizures or coma without any apparent cause. HELLP (hemolysis with elevated liver enzymes and low platelets) syndrome is another form of presentation of severe preeclampsia.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Clinical–epidemiological variables were recorded, together with laboratory test parameters, upon admission or at obstetric maneuvering. An analysis was made of maternal mortality and its related factors, during hospital admission due to causes related to gestosis, as well as of the factors related to the complications, referred to the development of heart failure (signs and symptoms of acute heart failure requiring oxygen therapy or mechanical ventilation—whether invasive or otherwise), coagulopathy (prothrombin activity decreased to below 50% or aPTT double the control value, or the existence of external or internal bleeding leading to patient destabilization and requiring the transfusion of blood products or surgery to secure control), or acute renal failure (characterized by doubling of the basal creatinine levels upon admission, or oligoanuria requiring extrarenal replacement measures). Likewise, the average duration of stay in the ICU was analyzed, along with the factors conditioning such a stay.The termination of gestation was indicated on the basis of the presence of serious maternal complications, fetal suffering, or the absence of growth during at least one week, despite adequate treatment. The decision relating to the indication and timing was established jointly with the Department of Gynecology.The patients and/or relatives were informed of the nature of the investigation and of its intended uses. Confidentiality was guaranteed at all times, with due confirmation that the information obtained would only be used for the specified purposes.Statistical analysisQuantitative variables were expressed as the mean±standard deviation (SD), while qualitative variables were reported as frequencies (percentage). In the case of quantitative variables, comparisons between groups were made with the Student's t-test or with the nonparametric Mann–Whitney U-test where pertinent. Analysis of variance (ANOVA) in turn was used for the comparison of more than two groups. In the case of qualitative variables, comparisons were made with the chi-squared test or Fisher exact test.Multivariate logistic regression analysis was used to identify predictors of mortality and the development of complications, while multiple linear regression was applied to the predictors of stay in the ICU. Those variables that proved significant in the bivariate analysis were included in the model.In all cases statistical significance was assumed for p<0.05, with a 95% confidence interval.ResultsThe study included 262 women with severe preeclampsia and a mean age of 30.47±5.7years, from among the 65,503 deliveries performed in our center. The incidence of severe preeclampsia in our series was 4/1000 deliveries. This implies that 0.37% of the patients hospitalized after giving birth required admission to the ICU due to severe preeclampsia, eclampsia or HELLP syndrome.The diagnostic distribution upon admission was as follows: 204 (78%) with severe preeclampsia, 42 (16%) with HELLP syndrome, and 16 (6%) with eclampsia, occurring in gestational week 31.8±4.4. Sixty-three percent of the patients were in their first pregnancy, with a low prevalence of smoking (3.44%), obesity (10.3%) or previous arterial hypertension (17.8%). Pregnancy terminated in the form of cesarean section in 90% of the cases.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> reports some clinical and epidemiological variables according to the type of diagnosis involved.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The gestational age of the women with eclampsia (35.6±5) was significantly greater than that of the patients with preeclampsia (32±4.2) or HELLP syndrome (30.9±3.8) (p=0.004 and p=0.001, respectively).Fourteen percent of the patients developed some types of complication, specifically heart failure in 23 subjects (9%), acute renal failure in 14 (5%) and coagulation disorders in 6 cases (2%). <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> reports the clinical and laboratory test parameters of the patients according to whether they developed complications or not. There were no significant differences in the appearance of complications according to the diagnosis upon admission, as can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>The mean systolic blood pressure (SBP) was 171.7±82.7, while the mean diastolic blood pressure (DBP) was 99±15. No association was found between the mean SBP–DBP values and the development of complications.The maternal mortality rate was 1.5% (2 patients diagnosed with severe preeclampsia and 2 with HELLP syndrome). First gestation was seen to be a protective factor in relation to maternal mortality (p=0.008), while mean transaminase concentration was correlated to increased mortality (p=0.0001).The mean stay in the ICU was 5.6±3.4days. The patients who experienced some complication showed a longer stay in the Unit 5.3±2.8 vs 8±5 (p=0.007); this association was retained on an isolated basis for heart failure and acute renal failure (p=0.004 and p=0.0001, respectively), but not for coagulopathy (p=0.7).The multivariate analysis of maternal mortality in all three disease conditions showed first pregnancy, the presence of complications, and GOT concentrations of over 71mg/dl to be explanatory factors for maternal mortality (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>The independent predictors of stay in ICU were hemoglobin level (p=0.005, 95%CI −0.6, −0.1) and age gestational at the time of delivery (p=0.001, 95%CI −0.2, −0.07). Stay in the ICU was the only independent predictor of the development of complications (p=0.0001, OR 0.8, 95%CI 0.7–0.9).DiscussionSevere preeclampsia, eclampsia and HELLP syndrome show a low incidence (4 cases/1000 deliveries) and low mortality (1.5%), though the associated complications rate is significant (14%), in the context of intensive care.Maternal mortality due to obstetric causes varies according to the setting involved. Thus, in western countries the mortality rate varies between 0.2% according to the series of Zeeman,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> involving only patients with gestosis, and 3% according to Gilbert et al.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> In less developed countries, maternal mortality is much higher: 33% in the series of Okafor in Nigeria,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> 22% in an Indian registry,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> almost 20% is a Tunisian series,<a class="elsevierStyleCrossRef" href="#bib0060">12</a> and 10% according to the Turkish series of Demirkirian<a class="elsevierStyleCrossRef" href="#bib0065">13</a>—all these being series published in the present decade. In our setting, Olarra et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> published a retrospective study in which the maternal mortality rate was 7.5% among 149 seriously ill pregnant women admitted over a 7-year period, of which 50 were admitted due to preeclampsia.Our series, referred exclusively to patients with severe preeclampsia, registered a maternal mortality rate of 1.5%—this percentage being similar to that reported by Zeeman<a class="elsevierStyleCrossRef" href="#bib0040">8</a> and other authors in western countries. Given the small number of deaths, no firm conclusions can be drawn.HELLP syndrome implies an increased maternal-fetal mortality risk. A hospital in our setting recorded a maternal mortality rate of 1.8%,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> vs 1% in the larger series published by Sibai et al.<a class="elsevierStyleCrossRef" href="#bib0080">16</a>The criteria referred to obstetric admission to specialized critical care units vary according to the prevalence of different diseases, geographical areas, operative definitions of morbidity, hospitalization criteria, and management and treatment protocols, among other relevant aspects—although an obstetric intensive care utilization rate of between 1% and 3% of all deliveries has been estimated, particularly due to severe preeclampsia and massive bleeding.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> In our center, 0.37% of the women seen in the hospital during the study period required admission to the ICU because of severe preeclampsia—this percentage being similar to those reported for other countries in our setting.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>Complications during stay in the ICU are related to a poorer prognosis, and constituted the parameter of greatest specific effect in the multivariate analysis. The incidence of acute renal failure in preeclampsia has not been clearly established. A recent review<a class="elsevierStyleCrossRef" href="#bib0090">18</a> of renal failure of obstetric origin points to preeclampsia as the cause of 20.9% of all renal failures in this setting, while another series including 31 complicated pregnancies with renal failure found 58% of the cases to be attributable to preeclampsia—giving rise to acute tubular necrosis—and one-half of the patients required hemodialysis during hospitalization.Another study examined in the aforementioned review found 5% of all cases of gestosis to be complicated by acute renal failure—this figure reaching 7.3% in the subgroup of patients with HELLP syndrome. On the other hand, most of the cases documented in the literature recovered normal kidney function in a variable period of time, in coincidence with our own patients.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>Among the cardiovascular changes occurring in preeclampsia, mention should be made of a decrease in cardiac output and an increase in peripheral vascular resistance. Terrone et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> recorded cardiac morbidity in 7.6% of a numerous series of women with preeclampsia and HELLP syndrome. In this subgroup of pregnant women, cesarean section predominated as the form of termination of pregnancy, with an increased incidence of low-weight infants, arterial hypertension and laboratory test anomalies. Heart failure and lung edema showed a similar frequency in preeclampsia and HELLP syndrome. Our series presented a slightly higher percentage (9%, 23 cases) of gestosis complicated by heart failure. The latter implies a significantly longer stay in the ICU compared with patients who do not suffer heart failure.The univariate analysis of the maternal complications only identified prolonged stay in the ICU as predictor, though this may have been due to the presence of complications. Thus, in our case, the multivariate model did not allow us to draw firm conclusions.The mean duration of stay in our patients was 5days, which coincides with the observations of other authors,<a class="elsevierStyleCrossRef" href="#bib0040">8</a> with no differences among the three diagnostic entities. It seems reasonable to assume that a longer mean stay implies a poorer course and a higher complications rate, and this was effectively found to be the case in our series. As independent predictors of stay in the ICU, the statistical analysis identified hemoglobin concentration and gestational age at delivery; accordingly, a lesser hemoglobin concentration or low gestational week was associated to a longer stay in the ICU, in relation to increased needs for monitorization and treatment. In the series published by Zeeman, longer stay was attributed to the need for temporary mechanical ventilation, blood product transfusions or inotropic drug support.The association between gestosis and first pregnancy remains the subject of controversy.<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a> In our series, first pregnancy was a frequent factor (62.9%), in coincidence with the observations of other authors<a class="elsevierStyleCrossRef" href="#bib0105">21</a>; however, first pregnancy is possibly overestimated as a risk factor for gestosis, since out of fear of suffering preeclampsia again on subsequent occasions, patients may tend to avoid further pregnancies.A recent metaanalysis<a class="elsevierStyleCrossRef" href="#bib0110">22</a> of 26 studies published between 1966 and 2005 concluded that the risk of preeclampsia is 2.42-fold greater in primiparous women than in multiparous patients—this observation being attributed to differences in immune response between primiparous and multiparous women, in angiogenic profile, or in insulin resistance reactivity pattern.The research program Pre-eclampsia Integrated Estimate of RiSk (PIERS), created with the purpose of developing a scale serving as a clinical practice and decision-taking guide in cases of maternal risk associated preeclampsia, established that most disease severity criteria show poor performance in predicting maternal-fetal morbidity–mortality. In contrast, standardized assessment and vigilance of patients with severe preeclampsia was seen to reduce maternal risk.<a class="elsevierStyleCrossRef" href="#bib0115">23</a> Accordingly, vigilance and monitorization of these patients in intensive care can allow the early detection of complications, with secondary benefits in relation to mortality.The limitations of our study are referred to the few conclusions that can be drawn in relation to mortality, due to the few deaths recorded in our series (1.5%), and the lack of specificity of some of the definitions used—such as renal failure—which have changed in recent years, without adaptation to more current classifications such as the RIFLE or the AKIN scale.In contrast, the positive aspects are the sample size involved—this being one of the largest series of severe gestosis published to date in Spain—and the specialized nature of the care provided (ICU of a third-level hospital, limited exclusively to gynecological-obstetric disease).Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres9136" "titulo" => array:8 [ 0 => "Abstract" 1 => "Objective" 2 => "Design" 3 => "Setting" 4 => "Patients" 5 => "Intervention" 6 => "Results" 7 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec10577" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres9137" "titulo" => array:8 [ 0 => "Resumen" 1 => "Objetivo" 2 => "Diseño" 3 => "Ámbito" 4 => "Pacientes" 5 => "Intervención" 6 => "Resultados" 7 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec10576" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-03-01" "fechaAceptado" => "2011-05-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec10577" "palabras" => array:6 [ 0 => "Severe preeclampsia" 1 => "Eclampsia" 2 => "HELLP syndrome" 3 => "Intensive care unit" 4 => "Complications" 5 => "Mortality" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec10576" "palabras" => array:6 [ 0 => "Preeclampsia grave" 1 => "Eclampsia" 2 => "Síndrome HELLP" 3 => "Unidad de cuidados intensivos" 4 => "Complicaciones" 5 => "Mortalidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo describe the incidence and clinical and epidemiological profile of patients with severe preeclampsia admitted to intensive care. DesignA prospective, observational case series. SettingA specific obstetric 8-bed ICU belonging to a university hospital with a total of 55 ICU beds. PatientsA total of 262 patients admitted due to severe preeclampsia, eclampsia or HELLP syndrome. InterventionDescriptive analysis of the population and complications in the ICU and hospital mortality. ResultsThe mean patient age was 30.47±5.7years, with the following diagnóstico at admission: A total of 78% of the patients with severe preeclampsia, 16% with HELLP syndrome, and 6% with eclampsia, occurring in gestational week 31.85±4.45. In turn, 63% of the patients were nulliparous and had a low prevalence of previous diseases. The global complications rate was 14% (9% heart failure, 5% acute renal failure and 2% coagulopathy).Maternal mortality was 1.5% (4 patients), and was associated with non-nulliparous status, the presence of complications, and toast >71mg/dl. ConclusionsSevere preeclampsia has a low mortality rate (1.5%), though the complications rate is considerable (14%). The condition develops more often in nulliparous women during the third trimester of pregnancy." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "ObjetivoDescribir la incidencia y el perfil clínico y epidemiológico de las pacientes con preeclampsia grave que requieren ingreso en Cuidados Intensivos. DiseñoEstudio observacional prospectivo de una serie de casos. ÁmbitoUCI específica de enfermedad gineco-obstétrica de 8 camas, perteneciente a un hospital universitario de nivel 3, con una dotación de 55 camas de UCI en total. PacientesUn total de 262 pacientes ingresadas por preeclampsia grave, eclampsia o síndrome HELLP. IntervenciónAnálisis descriptivo de la población y de las complicaciones en UCI así como de la mortalidad intrahospitalaria. ResultadosLa edad media fue de 30,47±5,7 años, con una distribución diagnóstica al ingreso de 78% de pacientes con preeclampsia grave, 16% por síndrome HELLP y 6% por eclampsia, que sucedió en la semana gestacional 31,85±4,45. El 63% de las pacientes fueron primigestas y presentaron escasa prevalencia de enfermedades previas. La tasa de complicaciones fue del 14% (fracaso cardiaco en 9%, insuficiencia renal aguda en 5% y coagulopatía en 2%).La mortalidad materna fue 1,5% (4 pacientes) y se relacionó con la no-primigestación, la presencia de complicaciones y un nivel superior de la transaminasa GOT a 71mg/dl. ConclusionesLa preeclampsia grave tiene una baja tasa de mortalidad (1,5%), no así de complicaciones (14%) y se presenta con mayor frecuencia en nulíparas durante el tercer trimestre de gestación." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Curiel-Balsera E, et al. Análisis de la morbimortalidad materna de las pacientes con preeclampsia grave, eclampsia y síndrome HELLP que ingresan en una Unidad de Cuidados Intensivos gineco-obstétrica. Med Intensiva. 2011;35:478–83." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 919 "Ancho" => 1628 "Tamanyo" => 80937 ] ] "descripcion" => array:1 [ "en" => "Complications according to the diagnosis upon admission." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Manifestations of central nervous system dysfunction: blurry vision, scotomas, severe headache, altered consciousness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Symptoms of Gleason capsule distension: severe pain in right hypochondrial region, nausea or vomiting \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Liver cell damage: transaminase elevation to twice the laboratory normal reference value \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Severe arterial hypertension: SBP ≥160mmHg or DBP ≥110mmHg on at least 2 occasions spaced 6h apart \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Thrombocytopenia: <100,000platelets per mm3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Proteinuria: ≥2g in 24h \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Oliguria <500ml in 24h \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Severe fetal growth retardation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Lung edema or cyanosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–Cerebrovascular stroke \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab8715.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Signs and symptoms of severe preeclampsia (at least one of the following)." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Preeclampsia (n=203) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Eclampsia (n=16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">HELLP syndrome (n=43) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29±7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30±6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First gestation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124 (61.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (68.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (69.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (11.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (18.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 (19.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (14%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gestational week upon admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31±4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stay in ICU (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6±3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab8713.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical-demographic characteristics according to diagnosis upon admission." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "GOT: aspartate aminotransferase; GPT: alanine aminotransferase; DBP: diastolic blood pressure; SBP: systolic blood pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">No complications (n=225) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Complications (n=37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30±6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (11.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.101 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (5.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First gestation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">142 (63.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (62.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gestational week upon admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32±4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.587 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">167±24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">168±19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.746 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DBP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99±16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">99±10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.812 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hemoglobin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10±2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelets \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">179.644±94.549 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">160.811±70.532 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOT (AST) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78±114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">143±417 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GPT (ALT) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81±98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104±228 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Uric acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.2±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.3±1.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.66 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stay (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5±3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8±5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab8712.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and laboratory test data according to the development of complications." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "β: beta-coefficient; GOT (AST): aspartate aminotransferase; SBP: systolic blood pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">β \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sig. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">95%CI</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Lower \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Upper \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First gestation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−5.283 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.026 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.526 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GOT (AST) ≤71mg/dl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−4.402 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.041 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.834 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Presence of complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.041 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.872 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.141 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.835 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Constant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.250 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.033 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab8714.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Multivariate analysis of maternal mortality." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => 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Analysis of maternal morbidity and mortality among patients admitted to Obstetric Intensive Care with severe preeclampsia, eclampsia or HELLP syndrome

Análisis de la morbimortalidad materna de las pacientes con preeclampsia grave, eclampsia y síndrome HELLP que ingresan en una Unidad de Cuidados Intensivos gineco-obstétrica

E. Curiel-Balsera

Corresponding author

emiliouci@telefonica.net

Corresponding author.

, M.Á. Prieto-Palomino, J. Muñoz-Bono, M.J. Ruiz de Elvira, J.L. Galeas, G. Quesada García

Unidad de Cuidados Intensivos Maternal, Hospital Regional Universitario Carlos Haya, Málaga, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Preeclampsia&#44; a relatively common hypertensive disorder during pregnancy&#44; manifests progressively and often gives rise to serious maternal and perinatal complications&#46; While the etiology of preeclampsia is not clear&#44; it is characterized by vasospasm and endothelial activation&#44; with hypertension and proteinuria&#44; after week 20 of pregnancy&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The incidence of preeclampsia is variable&#44; since many studies have used estimations based only on hospital samples&#8212;a situation that could explain the relatively frequently reported figure of up to 5&#8211;10&#37;&#44; depending on the healthcare levels of the hospitals in which the studies are made&#46; It has been estimated that about 7&#37; of all pregnant women develop preeclampsia&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> though the percentage could be higher in less favorable socioeconomic settings&#44; and in countries with a higher prevalence of cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Although few estimations have been made in Spain&#44; the existing data point to an incidence of 1&#8211;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Five percent of all cases of preeclampsia in turn ultimately progress toward eclampsia&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and in up to 19&#37; of the cases the condition can manifest as HELLP syndrome&#44; which is associated to increased morbidity&#8211;mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The adverse maternal consequences in preeclampsia are fundamentally attributable to dysfunction of the central nervous system&#44; liver or kidneys &#40;hemorrhagic stroke&#44; liver rupture or acute renal failure&#41;&#44; and to bleeding associated to thrombocytopenia&#46; Preeclampsia&#8211;eclampsia is one of the three most common causes of mortality in pregnant women&#44; together with thromboembolic disease and postpartum hemorrhage&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The criteria of severe preeclampsia were established by the Spanish Society of Gynecology and Obstetrics <span class="elsevierStyleItalic">&#40;Sociedad Espa&#241;ola de Ginecologia y Obstetricia&#41;</span> in 2006&#44; and refer to a subgroup of patients with increased maternal-fetal mortality and more frequent management in intensive care units &#40;ICUs&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The present study describes the epidemiology and risk and evolutive factors among patients with severe preeclampsia&#44; eclampsia and HELLP syndrome&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">A prospective observational study has been made of all the patients admitted to the maternal intensive care unit &#40;ICU&#41; of the Maternal-Children&#39;s Hospital pertaining to the Carlos Haya Hospital Complex &#40;M&#225;laga&#44; Spain&#41; due to severe preeclampsia&#44; eclampsia or HELLP syndrome&#44; between January 1999 and September 2008&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Maternal-Children&#39;s Hospital serves 50&#37; of the population of the city of M&#225;laga&#44; and is the only public hospital in the province equipped with a neonatal ICU&#46; As a result&#44; it is the reference center for patients with severe preeclampsia&#44; eclampsia or HELLP syndrome in cases of early gestational age&#46; The mentioned ICU is a specific&#44; 8-bed gynecological-obstetric unit pertaining to the Carlos Haya Regional University Hospital&#8212;a third-level center with a total of 55 intensive care beds&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Severe preeclampsia is defined by the presence of systolic blood pressure &#40;SBP&#41; &#8805;140<span class="elsevierStyleHsp" style=""></span>mmHg or diastolic blood pressure &#40;DBP&#41; &#8805;90<span class="elsevierStyleHsp" style=""></span>mmHg as determined by two or more measurements spaced at least 6<span class="elsevierStyleHsp" style=""></span>h apart&#44; together with proteinuria &#40;&#8805;300<span class="elsevierStyleHsp" style=""></span>mg in 24<span class="elsevierStyleHsp" style=""></span>h urine&#41;&#44; and some of the severity criteria indicated in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Eclampsia in turn is established when preeclampsia is accompanied by seizures or coma without any apparent cause&#46; HELLP &#40;hemolysis with elevated liver enzymes and low platelets&#41; syndrome is another form of presentation of severe preeclampsia&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical&#8211;epidemiological variables were recorded&#44; together with laboratory test parameters&#44; upon admission or at obstetric maneuvering&#46; An analysis was made of maternal mortality and its related factors&#44; during hospital admission due to causes related to gestosis&#44; as well as of the factors related to the complications&#44; referred to the development of heart failure &#40;signs and symptoms of acute heart failure requiring oxygen therapy or mechanical ventilation&#8212;whether invasive or otherwise&#41;&#44; coagulopathy &#40;prothrombin activity decreased to below 50&#37; or aPTT double the control value&#44; or the existence of external or internal bleeding leading to patient destabilization and requiring the transfusion of blood products or surgery to secure control&#41;&#44; or acute renal failure &#40;characterized by doubling of the basal creatinine levels upon admission&#44; or oligoanuria requiring extrarenal replacement measures&#41;&#46; Likewise&#44; the average duration of stay in the ICU was analyzed&#44; along with the factors conditioning such a stay&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The termination of gestation was indicated on the basis of the presence of serious maternal complications&#44; fetal suffering&#44; or the absence of growth during at least one week&#44; despite adequate treatment&#46; The decision relating to the indication and timing was established jointly with the Department of Gynecology&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The patients and&#47;or relatives were informed of the nature of the investigation and of its intended uses&#46; Confidentiality was guaranteed at all times&#44; with due confirmation that the information obtained would only be used for the specified purposes&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Quantitative variables were expressed as the mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation &#40;SD&#41;&#44; while qualitative variables were reported as frequencies &#40;percentage&#41;&#46; In the case of quantitative variables&#44; comparisons between groups were made with the Student&#39;s <span class="elsevierStyleItalic">t</span>-test or with the nonparametric Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>-test where pertinent&#46; Analysis of variance &#40;ANOVA&#41; in turn was used for the comparison of more than two groups&#46; In the case of qualitative variables&#44; comparisons were made with the chi-squared test or Fisher exact test&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Multivariate logistic regression analysis was used to identify predictors of mortality and the development of complications&#44; while multiple linear regression was applied to the predictors of stay in the ICU&#46; Those variables that proved significant in the bivariate analysis were included in the model&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In all cases statistical significance was assumed for <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; with a 95&#37; confidence interval&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">The study included 262 women with severe preeclampsia and a mean age of 30&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;7<span class="elsevierStyleHsp" style=""></span>years&#44; from among the 65&#44;503 deliveries performed in our center&#46; The incidence of severe preeclampsia in our series was 4&#47;1000 deliveries&#46; This implies that 0&#46;37&#37; of the patients hospitalized after giving birth required admission to the ICU due to severe preeclampsia&#44; eclampsia or HELLP syndrome&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The diagnostic distribution upon admission was as follows&#58; 204 &#40;78&#37;&#41; with severe preeclampsia&#44; 42 &#40;16&#37;&#41; with HELLP syndrome&#44; and 16 &#40;6&#37;&#41; with eclampsia&#44; occurring in gestational week 31&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&#46; Sixty-three percent of the patients were in their first pregnancy&#44; with a low prevalence of smoking &#40;3&#46;44&#37;&#41;&#44; obesity &#40;10&#46;3&#37;&#41; or previous arterial hypertension &#40;17&#46;8&#37;&#41;&#46; Pregnancy terminated in the form of cesarean section in 90&#37; of the cases&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> reports some clinical and epidemiological variables according to the type of diagnosis involved&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The gestational age of the women with eclampsia &#40;35&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#41; was significantly greater than that of the patients with preeclampsia &#40;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;2&#41; or HELLP syndrome &#40;30&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; respectively&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Fourteen percent of the patients developed some types of complication&#44; specifically heart failure in 23 subjects &#40;9&#37;&#41;&#44; acute renal failure in 14 &#40;5&#37;&#41; and coagulation disorders in 6 cases &#40;2&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> reports the clinical and laboratory test parameters of the patients according to whether they developed complications or not&#46; There were no significant differences in the appearance of complications according to the diagnosis upon admission&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The mean systolic blood pressure &#40;SBP&#41; was 171&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>82&#46;7&#44; while the mean diastolic blood pressure &#40;DBP&#41; was 99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46; No association was found between the mean SBP&#8211;DBP values and the development of complications&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The maternal mortality rate was 1&#46;5&#37; &#40;2 patients diagnosed with severe preeclampsia and 2 with HELLP syndrome&#41;&#46; First gestation was seen to be a protective factor in relation to maternal mortality &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41;&#44; while mean transaminase concentration was correlated to increased mortality &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The mean stay in the ICU was 5&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;4<span class="elsevierStyleHsp" style=""></span>days&#46; The patients who experienced some complication showed a longer stay in the Unit 5&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8 vs 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#59; this association was retained on an isolated basis for heart failure and acute renal failure &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#44; respectively&#41;&#44; but not for coagulopathy &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The multivariate analysis of maternal mortality in all three disease conditions showed first pregnancy&#44; the presence of complications&#44; and GOT concentrations of over 71<span class="elsevierStyleHsp" style=""></span>mg&#47;dl to be explanatory factors for maternal mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The independent predictors of stay in ICU were hemoglobin level &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#44; 95&#37;CI &#8722;0&#46;6&#44; &#8722;0&#46;1&#41; and age gestational at the time of delivery &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; 95&#37;CI &#8722;0&#46;2&#44; &#8722;0&#46;07&#41;&#46; Stay in the ICU was the only independent predictor of the development of complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#44; OR 0&#46;8&#44; 95&#37;CI 0&#46;7&#8211;0&#46;9&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">Severe preeclampsia&#44; eclampsia and HELLP syndrome show a low incidence &#40;4 cases&#47;1000 deliveries&#41; and low mortality &#40;1&#46;5&#37;&#41;&#44; though the associated complications rate is significant &#40;14&#37;&#41;&#44; in the context of intensive care&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Maternal mortality due to obstetric causes varies according to the setting involved&#46; Thus&#44; in western countries the mortality rate varies between 0&#46;2&#37; according to the series of Zeeman&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> involving only patients with gestosis&#44; and 3&#37; according to Gilbert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In less developed countries&#44; maternal mortality is much higher&#58; 33&#37; in the series of Okafor in Nigeria&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> 22&#37; in an Indian registry&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> almost 20&#37; is a Tunisian series&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and 10&#37; according to the Turkish series of Demirkirian<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#8212;all these being series published in the present decade&#46; In our setting&#44; Olarra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> published a retrospective study in which the maternal mortality rate was 7&#46;5&#37; among 149 seriously ill pregnant women admitted over a 7-year period&#44; of which 50 were admitted due to preeclampsia&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our series&#44; referred exclusively to patients with severe preeclampsia&#44; registered a maternal mortality rate of 1&#46;5&#37;&#8212;this percentage being similar to that reported by Zeeman<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and other authors in western countries&#46; Given the small number of deaths&#44; no firm conclusions can be drawn&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">HELLP syndrome implies an increased maternal-fetal mortality risk&#46; A hospital in our setting recorded a maternal mortality rate of 1&#46;8&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> vs 1&#37; in the larger series published by Sibai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The criteria referred to obstetric admission to specialized critical care units vary according to the prevalence of different diseases&#44; geographical areas&#44; operative definitions of morbidity&#44; hospitalization criteria&#44; and management and treatment protocols&#44; among other relevant aspects&#8212;although an obstetric intensive care utilization rate of between 1&#37; and 3&#37; of all deliveries has been estimated&#44; particularly due to severe preeclampsia and massive bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In our center&#44; 0&#46;37&#37; of the women seen in the hospital during the study period required admission to the ICU because of severe preeclampsia&#8212;this percentage being similar to those reported for other countries in our setting&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Complications during stay in the ICU are related to a poorer prognosis&#44; and constituted the parameter of greatest specific effect in the multivariate analysis&#46; The incidence of acute renal failure in preeclampsia has not been clearly established&#46; A recent review<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> of renal failure of obstetric origin points to preeclampsia as the cause of 20&#46;9&#37; of all renal failures in this setting&#44; while another series including 31 complicated pregnancies with renal failure found 58&#37; of the cases to be attributable to preeclampsia&#8212;giving rise to acute tubular necrosis&#8212;and one-half of the patients required hemodialysis during hospitalization&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Another study examined in the aforementioned review found 5&#37; of all cases of gestosis to be complicated by acute renal failure&#8212;this figure reaching 7&#46;3&#37; in the subgroup of patients with HELLP syndrome&#46; On the other hand&#44; most of the cases documented in the literature recovered normal kidney function in a variable period of time&#44; in coincidence with our own patients&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Among the cardiovascular changes occurring in preeclampsia&#44; mention should be made of a decrease in cardiac output and an increase in peripheral vascular resistance&#46; Terrone et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> recorded cardiac morbidity in 7&#46;6&#37; of a numerous series of women with preeclampsia and HELLP syndrome&#46; In this subgroup of pregnant women&#44; cesarean section predominated as the form of termination of pregnancy&#44; with an increased incidence of low-weight infants&#44; arterial hypertension and laboratory test anomalies&#46; Heart failure and lung edema showed a similar frequency in preeclampsia and HELLP syndrome&#46; Our series presented a slightly higher percentage &#40;9&#37;&#44; 23 cases&#41; of gestosis complicated by heart failure&#46; The latter implies a significantly longer stay in the ICU compared with patients who do not suffer heart failure&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The univariate analysis of the maternal complications only identified prolonged stay in the ICU as predictor&#44; though this may have been due to the presence of complications&#46; Thus&#44; in our case&#44; the multivariate model did not allow us to draw firm conclusions&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">The mean duration of stay in our patients was 5<span class="elsevierStyleHsp" style=""></span>days&#44; which coincides with the observations of other authors&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> with no differences among the three diagnostic entities&#46; It seems reasonable to assume that a longer mean stay implies a poorer course and a higher complications rate&#44; and this was effectively found to be the case in our series&#46; As independent predictors of stay in the ICU&#44; the statistical analysis identified hemoglobin concentration and gestational age at delivery&#59; accordingly&#44; a lesser hemoglobin concentration or low gestational week was associated to a longer stay in the ICU&#44; in relation to increased needs for monitorization and treatment&#46; In the series published by Zeeman&#44; longer stay was attributed to the need for temporary mechanical ventilation&#44; blood product transfusions or inotropic drug support&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The association between gestosis and first pregnancy remains the subject of controversy&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> In our series&#44; first pregnancy was a frequent factor &#40;62&#46;9&#37;&#41;&#44; in coincidence with the observations of other authors<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#59; however&#44; first pregnancy is possibly overestimated as a risk factor for gestosis&#44; since out of fear of suffering preeclampsia again on subsequent occasions&#44; patients may tend to avoid further pregnancies&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A recent metaanalysis<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> of 26 studies published between 1966 and 2005 concluded that the risk of preeclampsia is 2&#46;42-fold greater in primiparous women than in multiparous patients&#8212;this observation being attributed to differences in immune response between primiparous and multiparous women&#44; in angiogenic profile&#44; or in insulin resistance reactivity pattern&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The research program <span class="elsevierStyleItalic">Pre-eclampsia Integrated Estimate of RiSk</span> &#40;PIERS&#41;&#44; created with the purpose of developing a scale serving as a clinical practice and decision-taking guide in cases of maternal risk associated preeclampsia&#44; established that most disease severity criteria show poor performance in predicting maternal-fetal morbidity&#8211;mortality&#46; In contrast&#44; standardized assessment and vigilance of patients with severe preeclampsia was seen to reduce maternal risk&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Accordingly&#44; vigilance and monitorization of these patients in intensive care can allow the early detection of complications&#44; with secondary benefits in relation to mortality&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The limitations of our study are referred to the few conclusions that can be drawn in relation to mortality&#44; due to the few deaths recorded in our series &#40;1&#46;5&#37;&#41;&#44; and the lack of specificity of some of the definitions used&#8212;such as renal failure&#8212;which have changed in recent years&#44; without adaptation to more current classifications such as the RIFLE or the AKIN scale&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In contrast&#44; the positive aspects are the sample size involved&#8212;this being one of the largest series of severe gestosis published to date in Spain&#8212;and the specialized nature of the care provided &#40;ICU of a third-level hospital&#44; limited exclusively to gynecological-obstetric disease&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            3 => "&#193;mbito"
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            0 => "Severe preeclampsia"
            1 => "Eclampsia"
            2 => "HELLP syndrome"
            3 => "Intensive care unit"
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            0 => "Preeclampsia grave"
            1 => "Eclampsia"
            2 => "S&#237;ndrome HELLP"
            3 => "Unidad de cuidados intensivos"
            4 => "Complicaciones"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the incidence and clinical and epidemiological profile of patients with severe preeclampsia admitted to intensive care&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective&#44; observational case series&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A specific obstetric 8-bed ICU belonging to a university hospital with a total of 55 ICU beds&#46;</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 262 patients admitted due to severe preeclampsia&#44; eclampsia or HELLP syndrome&#46;</p> <span class="elsevierStyleSectionTitle">Intervention</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Descriptive analysis of the population and complications in the ICU and hospital mortality&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The mean patient age was 30&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;7<span class="elsevierStyleHsp" style=""></span>years&#44; with the following diagn&#243;stico at admission&#58; A total of 78&#37; of the patients with severe preeclampsia&#44; 16&#37; with HELLP syndrome&#44; and 6&#37; with eclampsia&#44; occurring in gestational week 31&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;45&#46; In turn&#44; 63&#37; of the patients were nulliparous and had a low prevalence of previous diseases&#46; The global complications rate was 14&#37; &#40;9&#37; heart failure&#44; 5&#37; acute renal failure and 2&#37; coagulopathy&#41;&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Maternal mortality was 1&#46;5&#37; &#40;4 patients&#41;&#44; and was associated with non-nulliparous status&#44; the presence of complications&#44; and toast &#62;71<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Severe preeclampsia has a low mortality rate &#40;1&#46;5&#37;&#41;&#44; though the complications rate is considerable &#40;14&#37;&#41;&#46; The condition develops more often in nulliparous women during the third trimester of pregnancy&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Describir la incidencia y el perfil cl&#237;nico y epidemiol&#243;gico de las pacientes con preeclampsia grave que requieren ingreso en Cuidados Intensivos&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional prospectivo de una serie de casos&#46;</p> <span class="elsevierStyleSectionTitle">&#193;mbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">UCI espec&#237;fica de enfermedad gineco-obst&#233;trica de 8 camas&#44; perteneciente a un hospital universitario de nivel 3&#44; con una dotaci&#243;n de 55 camas de UCI en total&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Un total de 262 pacientes ingresadas por preeclampsia grave&#44; eclampsia o s&#237;ndrome HELLP&#46;</p> <span class="elsevierStyleSectionTitle">Intervenci&#243;n</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis descriptivo de la poblaci&#243;n y de las complicaciones en UCI as&#237; como de la mortalidad intrahospitalaria&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La edad media fue de 30&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;7 a&#241;os&#44; con una distribuci&#243;n diagn&#243;stica al ingreso de 78&#37; de pacientes con preeclampsia grave&#44; 16&#37; por s&#237;ndrome HELLP y 6&#37; por eclampsia&#44; que sucedi&#243; en la semana gestacional 31&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;45&#46; El 63&#37; de las pacientes fueron primigestas y presentaron escasa prevalencia de enfermedades previas&#46; La tasa de complicaciones fue del 14&#37; &#40;fracaso cardiaco en 9&#37;&#44; insuficiencia renal aguda en 5&#37; y coagulopat&#237;a en 2&#37;&#41;&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La mortalidad materna fue 1&#44;5&#37; &#40;4 pacientes&#41; y se relacion&#243; con la no-primigestaci&#243;n&#44; la presencia de complicaciones y un nivel superior de la transaminasa GOT a 71<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La preeclampsia grave tiene una baja tasa de mortalidad &#40;1&#44;5&#37;&#41;&#44; no as&#237; de complicaciones &#40;14&#37;&#41; y se presenta con mayor frecuencia en nul&#237;paras durante el tercer trimestre de gestaci&#243;n&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Curiel-Balsera E&#44; et al&#46; An&#225;lisis de la morbimortalidad materna de las pacientes con preeclampsia grave&#44; eclampsia y s&#237;ndrome HELLP que ingresan en una Unidad de Cuidados Intensivos gineco-obst&#233;trica&#46; Med Intensiva&#46; 2011&#59;35&#58;478&#8211;83&#46;</p>"
      ]
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Complications according to the diagnosis upon admission&#46;</p>"
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      1 => array:7 [
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                0 => """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Manifestations of central nervous system dysfunction&#58; blurry vision&#44; scotomas&#44; severe headache&#44; altered consciousness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Symptoms of Gleason capsule distension&#58; severe pain in right hypochondrial region&#44; nausea or vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Liver cell damage&#58; transaminase elevation to twice the laboratory normal reference value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Severe arterial hypertension&#58; SBP &#8805;160<span class="elsevierStyleHsp" style=""></span>mmHg or DBP &#8805;110<span class="elsevierStyleHsp" style=""></span>mmHg on at least 2 occasions spaced 6<span class="elsevierStyleHsp" style=""></span>h apart&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Thrombocytopenia&#58; &#60;100&#44;000<span class="elsevierStyleHsp" style=""></span>platelets per mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Proteinuria&#58; &#8805;2<span class="elsevierStyleHsp" style=""></span>g in 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Oliguria &#60;500<span class="elsevierStyleHsp" style=""></span>ml in 24<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Severe fetal growth retardation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Lung edema or cyanosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;<span class="elsevierStyleHsp" style=""></span>Cerebrovascular stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Signs and symptoms of severe preeclampsia &#40;at least one of the following&#41;&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Preeclampsia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>203&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Eclampsia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">HELLP syndrome &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">First gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124 &#40;61&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;68&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;69&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;11&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;19&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gestational week upon admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stay in ICU &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Clinical-demographic characteristics according to diagnosis upon admission&#46;</p>"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">GOT&#58; aspartate aminotransferase&#59; GPT&#58; alanine aminotransferase&#59; DBP&#58; diastolic blood pressure&#59; SBP&#58; systolic blood pressure&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">No complications &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>225&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Complications &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;11&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">First gestation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">142 &#40;63&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;62&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gestational week upon admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">168<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;746&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DBP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;812&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hemoglobin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Platelets&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179&#46;644<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>94&#46;549&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&#46;811<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#46;532&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GOT &#40;AST&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>417&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GPT &#40;ALT&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uric acid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab8712.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Clinical and laboratory test data according to the development of complications&#46;</p>"
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      4 => array:7 [
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">&#946;</span>&#58; beta-coefficient&#59; GOT &#40;AST&#41;&#58; aspartate aminotransferase&#59; SBP&#58; systolic blood pressure&#46;</p>"
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            0 => array:2 [
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#946;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sig&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">OR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">95&#37;CI</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">First gestation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;026&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;526&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2011.11.005

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