title: Risk factors for post-partum complications occurring after preeclampsia and HELLP syndrome. A study in 453 consecutive pregnancies.
abstract: OBJECTIVE
  To evaluate complications that occurred during the post-partum period for patients with preeclampsia or HELLP syndrome.
  
  
  METHODS
  Retrospective analysis of 453 patients. The main outcome measures were maternal complications during post-partum period: fever >38.5 degrees C with proved infection, abdominal or perineal abscess, thrombo-embolic events, reoperation, need for blood transfusion, acute renal failure, eclampsia or disseminated intravascular coagulation. Statistic tests included univariate and multivariate analysis with stepwise descending logistic regression.
  
  
  RESULTS
  Patients were divided into 305 preeclampsia (67.3%) and 20 HELLP syndrome (4.4%), 128 (28.3%) had both. Eighty-five patients (18.8%) had at least one post-partum complication. The most frequent complication was infection: fever (41 patients, 9.1%) and abscess (30 patients, 6.6%). Twenty-six transfusions (5.7%), 10 disseminated intravascular coagulation (2.2%), seven thromboembolic events (1.5%), seven reoperations (1.5%) and one eclampsia (0.2%) were observed. There was no acute renal failure, no pulmonary oedema and no maternal death. Stepwise logistic regression showed five independent risk factors associated with post-partum complications: ascites or pulmonary oedema (OR: 1.84, 95% CI: 1.01-3.37), platelet count <100000/mm3 (OR: 1.96, 95% CI: 1.18-3.26), serum acid uric >360 micromol/l (OR: 2.36, 95% CI: 1.22-4.52), serum creatinine >120 micromol/l (OR: 2.99, 95% CI: 1.32-6.78), and proteinuria >5 g/l (OR: 1.80, 95% CI: 1.06-3.05).
  
  
  CONCLUSIONS
  We conclude that severity criteria for preeclampsia or HELLP syndrome combined with caesarean section increased the risk of complication during the post-partum period.
authors.affiliation: Clinique d'Obstétrique, Hôpital Jeanne de Flandre, CHRU de LILLE, 1 rue Eugène Avinée, 59037 Lille Cedex, France. p-deruelle@chru-lille.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Deruelle
authors.forename: Elodie
authors.initials: E
authors.lastname: Coudoux
authors.forename: Anne
authors.initials: A
authors.lastname: Ego
authors.forename: Véronique
authors.initials: V
authors.lastname: Houfflin-Debarge
authors.forename: Xavier
authors.initials: X
authors.lastname: Codaccioni
authors.forename: Damien
authors.initials: D
authors.lastname: Subtil
mesh_terms: D000038:Abscess / Q000209:etiology; D000328:Adult; D001201:Ascites / Q000150:complications; D002585:Cesarean Section / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D017359:HELLP Syndrome; D006801:Humans; D011225:Pre-Eclampsia; D011247:Pregnancy; D011507:Proteinuria / Q000150:complications; D011644:Puerperal Disorders / Q000209:etiology*; D011645:Puerperal Infection / Q000209:etiology; D011654:Pulmonary Edema / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D013921:Thrombocytopenia / Q000150:complications; D013923:Thromboembolism / Q000209:etiology; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid; D003404:Creatinine