Preeclampsia as a life-threatening condition

Objective. To investigate clinical and laboratory criteria for the “reference point” of the progression of severe preeclampsia (PE) into a life-threatening condition with a different outcome (near miss or maternal death). Subjects and methods. The investigators conducted a multicenter study conducted through an examination of 18,130 records of severe PE-complicated labors and deliveries. The study period was January 1, 2013 to December 31, 2018. There were 27 Moscow participating centers. A total of 122 delivery records were selected from women with PE and life-threatening conditions that led to near misses in 100 patients (a near miss group) and to maternal deaths in 22 women (a MD group). Results. Within less than 24 hours, severe PE can develop into a life-threatening condition and result in MD in women aged 18-45 years after natural conception at 24 weeks’ gestation (up to 34 weeks in 50%), with a blood pressure of less than 160/100 mm Hg, the baseline level of creatinine from 33.0 to 349.5 μmol/L and its increase by 9.47 times, that of platelets from 10.0 to 362.010⁹/L and their increase by 0.04–1.0 time, that of bilirubin from 5.0 to 104.0 μmol/L and its increase by 1.56–24.63 times, that of ALT from 8.7 to 807.0 U/L and its increase by 1.0–318.8 times, that of AST from 15.0 to 1238.0 U/L and its increase by 1.68–429.53 times, that of LDH from 568,4 to 2315,0 U/L and its increase by 2.79–9.89 times; moreover, 22.73% of cases can have no pathognomonic complaints and have a satisfactory general condition. Conclusion. PE should be considered as a condition with much more variability in outcomes, such as pre-stroke, pre-HELLP syndrome, pre-hepatic, prerenal, or multiple organ dysfunctions, etc. It is extremely difficult to predict MD. PE can manifest as a life-threatening condition within a few hours, possibly in the absence of elevated blood pressure. Critical liver failure competes by significance in the risks of MD with high blood pressure. The reference point from the diagnosis of PE to a life-threatening condition may be accompanied by the values of clinical and laboratory markers, which do not meet not only the criteria for near miss, but also severe PE. Timely delivery tactics is a fundamental measure for the prevention of life-threatening complications and MD. © 2020, Bionika Media Ltd.. All rights reserved.