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1.
Hypertens Pregnancy ; 40(4): 279-287, 2021 Nov.
Article in English | MEDLINE | ID: mdl-34587828

ABSTRACT

OBJECTIVES: To explore variables associated with adverse maternal/fetal/neonatal outcomes among pregnant/postpartum patients admitted to ICU for hypertensive disorders of pregnancy (HDP). METHODS: Multicenter, prospective, national cohort study. RESULTS: Variables independently associated with maternal/fetal/neonatal mortality among 172 patients were as follows: Acute Physiology and Chronic Health Evaluation-II (APACHE-II)(OR1.20[1.06-1.35]), gestational age (OR0.698[0.59-0.82]) and aspartate aminotransferase (AST)(OR1.004[1.001-1.006]). Positive likelihood ratio for headache, epigastric pain, and visual disturbances to predict composite adverse outcomes were 1.23(1.16-1.30), 0.76(0.59-1.02), and 1.1(0.98-1.2), respectively. CONCLUSIONS: Maternal/fetal mortality due to HDP was independently associated with severity of illness on admission, gestational age, and elevated AST. Accuracy of clinical symptoms to predict composite adverse outcomes was low.


Subject(s)
Hypertension, Pregnancy-Induced/epidemiology , Pre-Eclampsia/epidemiology , Pregnancy Outcome/epidemiology , Cohort Studies , Female , Humans , Infant, Newborn , Predictive Value of Tests , Pregnancy , Prospective Studies , Risk Factors
2.
A A Pract ; 13(3): 102-106, 2019 Aug 01.
Article in English | MEDLINE | ID: mdl-30920425

ABSTRACT

Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. Transitory stabilization prompted surgeons to postpone hernia repair, but an urgent thoracotomy was required to relieve a subsequent bowel obstruction that was complicated by an intrathoracic colonic perforation. Emergent cesarean delivery was required with a good maternal and fetal outcome. A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.


Subject(s)
Hernias, Diaphragmatic, Congenital/diagnosis , Pregnancy Complications/diagnosis , Adult , Cesarean Section , Female , Hernias, Diaphragmatic, Congenital/surgery , Herniorrhaphy , Humans , Intestinal Obstruction/surgery , Intestinal Perforation/surgery , Pregnancy , Pregnancy Complications/surgery
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