title: How accurate are maternal symptoms in predicting impending complications in women with preeclampsia? A systematic review and meta-analysis.
abstract: BACKGROUND
  Maternal symptoms such as severe headache, nausea and vomiting, visual disturbances and epigastric pain have been associated with complications in women with preeclampsia.
  
  
  OBJECTIVE
  To determine the accuracy of maternal symptoms in predicting complications in women with preeclampsia by systematic review.
  
  
  METHODS
  We searched MEDLINE (1951-2010), EMBASE (1980-2010), the Cochrane Library (2009) and the MEDION database.
  
  
  METHODS
  Studies which evaluated the accuracy of symptoms in women with preeclampsia for predicting complications were selected in a two-stage process. Information was extracted by two independent reviewers. We summarized accuracy with a bivariate model estimating sensitivity, specificity and area under the curve.
  
  
  RESULTS
  Six primary articles with 2573 women were included. The area under the curve for predicting complications for headache, epigastric pain and visual disturbances was 0.58 (95%CI 0.24-0.86), 0.70 (95%CI 0.30-0.93) and 0.74 (95%CI 0.33-0.94). The sensitivity and specificity of the symptoms in predicting adverse maternal outcomes were respectively as follows: headache 0.54 (95%CI 0.27-0.79) and 0.59 (95%CI 0.38-0.76); epigastric pain 0.34 (95%CI 0.22-0.5) and 0.83 (95%CI 0.76-0.89); visual disturbances 0.27 (95%CI 0.07-0.65) and 0.81 (95%CI 0.71, 0.88); nausea and vomiting 0.24 (95%CI 0.21, 0.27) and 0.87 (95%CI 0.85, 0.89).
  
  
  CONCLUSIONS
  The presence of symptoms is more useful in predicting complications in preeclampsia compared to their absence in excluding adverse events.
authors.affiliation: Centre for Health Sciences, Institute of Health Sciences Education, Queen Mary University of London, Whitechapel, London, UK. s.thangaratinam@gmail.com
authors.forename: Shakila
authors.initials: S
authors.lastname: Thangaratinam
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Gallos
authors.forename: Neki
authors.initials: N
authors.lastname: Meah
authors.forename: Sa'ada
authors.initials: S
authors.lastname: Usman
authors.forename: Khaled M K
authors.initials: KM
authors.lastname: Ismail
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000037:Abruptio Placentae / Q000175:diagnosis*; D019540:Area Under Curve; D016022:Case-Control Studies; D004461:Eclampsia / Q000175:diagnosis*; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis*; D006261:Headache / Q000209:etiology; D006801:Humans; D009325:Nausea / Q000209:etiology; D011225:Pre-Eclampsia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014786:Vision Disorders / Q000209:etiology; D014839:Vomiting / Q000209:etiology