title: Maternal outcomes according to mode of delivery in women with severe preeclampsia: a cohort study.
abstract: OBJECTIVE
  To determine the association between mode of delivery and maternal complications in patients with severe preeclampsia.
  
  
  METHODS
  A prospective cohort study was conducted with 500 pregnant women with severe preeclampsia. The mode of delivery, vaginal or caesarean section, was considered the exposure, while the postpartum maternal complications and severe maternal morbidity were the outcomes. Logistic regression analysis was performed to determine the adjusted risk and 95% confidence intervals (95% CI) of maternal morbidity.
  
  
  RESULTS
  Labour was spontaneous in 22.0% and induced in 28.2%, while 49.8% had an elective caesarean section. Ninety-five (67.4%) of the patients in whom labour was induced delivered vaginally. Total Caesarean rate was 68.2%. The risk of severe maternal morbidity was significantly greater in patients submitted to Caesarean section (54.0% versus 32.7%) irrespective of the presence of labour. Factors that remained associated with severe maternal morbidity following multivariate analysis were a diagnosis of HELLP syndrome after delivery (OR = 3.73; 95% CI: 1.55-9.88) and having a caesarean (OR = 1.91; 95% CI: 1.52-4.57).
  
  
  CONCLUSIONS
  Caesareans are often performed in patients with severe preeclampsia and are associated with significant postpartum maternal morbidity. Induction of labour should be considered a feasible option in these patients.
authors.affiliation: Department of Maternal and Child Health, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) , Recife, Pernambuco , Brazil .
authors.forename: Melania M R
authors.initials: MM
authors.lastname: Amorim
authors.forename: Leila
authors.initials: L
authors.lastname: Katz
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Barros
authors.forename: Tainara S F
authors.initials: TS
authors.lastname: Almeida
authors.forename: Alex Sandro R
authors.initials: AS
authors.lastname: Souza
authors.forename: Aníbal
authors.initials: A
authors.lastname: Faúndes
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D017359:HELLP Syndrome / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D009035:Mothers / Q000706:statistics & numerical data*; D011225:Pre-Eclampsia / Q000453:epidemiology* / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Caesarean; complications; delivery; labour; obstetrics; pre-eclampsia; prognosis