title: Using clinical symptoms to predict adverse maternal and perinatal outcomes in women with preeclampsia: data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study.
abstract: OBJECTIVE
  Preeclampsia is a leading cause of maternal morbidity. The clinical challenge lies in predicting which women with preeclampsia will suffer adverse outcomes and would benefit from treatment, while minimizing potentially harmful interventions. Our aim was to determine the ability of maternal symptoms (i.e., severe nausea or vomiting, headache, visual disturbance, right upper quadrant pain or epigastric pain, abdominal pain or vaginal bleeding, and chest pain or dyspnea) to predict adverse maternal or perinatal outcomes.
  
  
  METHODS
  We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a multicentre, prospective cohort study designed to investigate the maternal risks associated with preeclampsia. Relative risks and receiver operating characteristic (ROC) curves were assessed for each preeclampsia symptom and outcome pair.
  
  
  RESULTS
  Of 2023 women who underwent assessment, 52% experienced at least one preeclampsia symptom, with 5.2% and 5.3% respectively experiencing an adverse maternal or perinatal outcome. No symptom and outcome pair, in either of the maternal or perinatal groups, achieved an area under the ROC curve value > 0.7, which would be necessary to demonstrate a discriminatory predictive value.
  
  
  CONCLUSIONS
  Maternal symptoms of preeclampsia are not independently valid predictors of maternal adverse outcome. Caution should be used when making clinical decisions on the basis of symptoms alone in the preeclamptic patient.
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
authors.forename: Tin-Wing
authors.initials: TW
authors.lastname: Yen
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC.
authors.forename: Beth
authors.initials: B
authors.lastname: Payne
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC.
authors.forename: Ziguang
authors.initials: Z
authors.lastname: Qu
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC; School of Public and Population Health, University of British Columbia, Vancouver BC.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hutcheon
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC.
authors.forename: Tang
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC; School of Public and Population Health, University of British Columbia, Vancouver BC.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
authors.affiliation: Department of Medicine, King Edward Memorial Hospital, Subiaco WA, Australia; Department of Obstetrics and Gynaecology, King Edward Memorial Hospital, Subiaco WA, Australia.
authors.forename: Barry N
authors.initials: BN
authors.lastname: Walters
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; The Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, University of British Columbia, Vancouver BC; School of Public and Population Health, University of British Columbia, Vancouver BC.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors