title: Morbidity and mortality associated with pre-eclampsia at two tertiary care hospitals in Sri Lanka.
abstract: OBJECTIVE
  To report the occurrence of morbidity and mortality associated with carefully phenotyped pre-eclampsia in a sample of nulliparous Sinhalese women with strictly defined disease.
  
  
  METHODS
  A phenotyping database of 180 nulliparous women with pre-eclampsia and 180 nulliparous normotensive pregnant women who were recruited for a study into genetics of pre-eclampsia was analyzed.
  
  
  RESULTS
  Women who developed pre-eclampsia had significantly higher systolic blood pressure (SBP; P = 0.002) and diastolic blood pressure (DBP; P = 0.002) at booking (at approximately 13 weeks of gestation). 38.3%, 28.3% and 33.3% of women delivered at <34 weeks, at 34-36 weeks, and at term, respectively. 78% required a cesarean section. Complications included SBP > or = 160 mmHg (75.5%); DBP > or = 110 mmHg (83.8%); proteinuria > or =3 + (150 mg/dL) in the urine protein heat coagulation test (87%); renal failure requiring dialysis (2%); platelet counts <100 x 10(9)/L (13%); > or =70 U/L in aspartate and/or alanine aminotransaminase (15%); placental abruption (4%); eclampsia (9%); and one maternal death. Maternal complications indicative of severe disease, apart from the incidence of SBP > or = 160 mmHg and DBP > or = 110 mmHg, were not significantly different in early and late-onset pre-eclampsia; fetal outcome was better with late-onset disease. 48% of babies were small for gestational age. Only 80 of 135 babies of women with pre-eclampsia whose condition could be confirmed at 6 weeks post-partum were alive.
  
  
  CONCLUSIONS
  Pre-eclampsia in Sinhalese women is associated with severe maternal morbidity and fetal morbidity and mortality, suggesting that modification of the Western diagnostic criteria and/or guidelines for medical care may be necessary. There is an urgent need to improve neonatal intensive care services in Sri Lanka.
authors.affiliation: Human Genetics Unit, Faculty of Medicine, University of Colombo, Sri Lanka. vajirahwd@hotmail.com
authors.forename: Vajira H W
authors.initials: VH
authors.lastname: Dissanayake
authors.forename: Harshana D
authors.initials: HD
authors.lastname: Samarasinghe
authors.forename: Linda
authors.initials: L
authors.lastname: Morgan
authors.forename: Rohan W
authors.initials: RW
authors.lastname: Jayasekara
authors.forename: Harshalal R
authors.initials: HR
authors.lastname: Seneviratne
authors.forename: Fiona
authors.initials: F
authors.lastname: Broughton Pipkin
mesh_terms: D000328:Adult; D005260:Female; D006761:Hospitals; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000401:mortality; D011225:Pre-Eclampsia / Q000401:mortality*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000401:mortality; D011256:Pregnancy Outcome; D013188:Sri Lanka / Q000453:epidemiology