Risk factors of maternal death in preeclampsia

Aim. To determine the factors contributing to maternal death due to preeclampsia.

Materials and Methods. We performed a retrospective study of 149 maternal deaths from preeclampsia during 2013-2017, which included the analysis of birth histories, medical records, individual observation cards, outpatient records, and questionnaires of healthcare workers and relatives.

Results. Preeclampsia was responsible for 24.1% of maternal deaths over 5 years (2013-2017). The causes of death in women with preeclampsia were: pulmonary oedema (33/149, 22.2% cases), acute renal failure (33/149, 22.2%), cerebral complications (43/149, 28.6%), and hepatic impairment (acute fatty liver of pregnancy or HELLP syndrome, 45/149, 30.2%). The majority of pregnant women admitted in critical condition because of acute fatty liver of pregnancy or HELLP syndrome (45/149, 30.2%), eclampsia at home (25/149, 16.8%), or severe hypertension (114/149, 76.5%). The majority of those who died from preeclampsia had premature births (86/149, 57.7%) and delivered by caesarean section (117, 78.5%), yet the latter was associated with a higher risk of maternal death in case of preeclampsia (OR = 30.028. 95% CI = 15.277-59.022) as compared with vaginal delivery. Risk factors of the maternal death in preeclampsia included late hospitalization (66% of deaths), inadequate antenatal care (64.4%), incorrect route of examination and hospitalization (31.6%), underestimation of the patient's condition (42.3 %), insufficient monitoring during pregnancy, childbirth and post childbirth (48.8%), and insufficient teamwork of medical staff (42.2%).

Conclusions. Insufficient knowledge of preeclampsia symptoms by pregnant women and their families, insufficient monitoring of blood pressure, underestimation of organ dysfunction, late hospital admission, late delivery, insufficient antihypertensive therapy, delivery at elevated blood pressure, and insufficient teamwork of healthcare professionals increase the risk of maternal mortality in the patients with preeclampsia.

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