Fetal death in eclampsia: I. Its relation to low gestational age, retarded fetal growth and low birthweight

Fetal growth retardation in infants of multiparous and nulliparous women with preeclampsia

OBJECTIVE

Infants of women with preeclampsia are considered at high risk of fetal growth retardation. The purpose of our study was to determine whether the risk differed by parity.

STUDY DESIGN

We compared the outcomes of 133 case patients with preeclampsia (101 nulliparous women and 32 multiparous women) and 132 normotensive control patients (52 nulliparous women and 80 multiparous women) who delivered at Northern California Kaiser Permanente hospitals between 1984 and 1985.

RESULTS

Women with preeclampsia were more likely than control patients to deliver a small-for-gestational-age infant (adjusted odds ratio 7.0, 95% confidence interval 2.8 to 18.1). After we controlled for smoking status, age, Quetelet index, and race, multiparous women with preeclampsia were at greater risk of having a small-for-gestational-age infant (adjusted odds ratio 29.4, 95% confidence interval 5.2 to 167.5) than were nulliparous women (adjusted odds ratio 4.1, 95% confidence interval 1.2 to 14.1) when compared with normotensive control patients of similar parity. Although multiparous women with preeclampsia had higher mean arterial pressures and somewhat earlier onsets of elevated mean arterial pressure than nulliparous women with preeclampsia, neither of these variables predicted whether the infants would be small for gestational age.

CONCLUSION

Multiparous women with preeclampsia are at higher risk of having an infant with fetal growth retardation than are nulliparous women with preeclampsia.

New-onset ventricular tachycardia during pregnancy

During evaluation for palpitations, presyncope, or syncope, seven pregnant women had documented ventricular tachycardia. Before pregnancy none had a history of significant cardiac disease or symptomatic arrhythmia. The tachycardia rate ranged from 117 to 250 beats/min and lasted up to 65 seconds. Arrhythmia evaluation in five of the patients suggested catecholamine-sensitive ventricular tachycardia. This diagnosis was supported by either a positive relation to exercise or isoproterenol infusion, suppression of arrhythmia by beta-blockade or sleep, and lack of induction of arrhythmia by programmed electrical stimulation of the heart. The arrhythmias resolved in one patient soon after evaluation and in one other patient after 2 months of controlling therapy. Five other patients continued to receive therapy throughout pregnancy. Delivery was accomplished in all patients without significant maternal or neonatal complications.

Possible treatment of pre-eclampsia with calcium channel blocking agents

A review of the pathophysiology and treatment of pre-eclampsia indicates that vasospasm and vascular hyperreactivity are important elements in the disease process and its control. Five requirements for a therapeutic agent in pre-eclampsia are identified: control of generalized vasospasm, hypertension, and eclamptic convulsions, maintenance of placental perfusion, and lack of adverse effects on the fetus/neonate. Calcium channel blocking agents are well known arteriolar vasodilators and inhibitors of coronary artery vasospasm, and appear to possess qualities relevant to these therapeutic requirements for pre-eclampsia. It is proposed that calcium channel blocking agents may be effective agents in the management of pre-eclampsia.

Ultrasonic features of preeclampsia

Preeclampsia, the hypertension of pregnancy, is a high-risk obstetric situation that can be monitored ultrasonically. Ultrasonic features commonly associated with preeclampsia, including decreased total intrauterine volume (TIUV), oligohydramnios, and intrauterine growth retardation (IUGR), are presented and their possible prognostic implications discussed.

Fetal death in eclampsia: II. The effect of non-therapeutic factors

The ability of 15 variables to predict fetal death is examined among 173 eclamptic women admitted to the only public maternity hospital in Cali, Colombia, between 1st Janurary 1964 and 31st December 1970. In addition to low gestational age and retarded fetal growth, high systolic pressure and the unmarried status carried excess risk. Primiparae appeared to be of lower risk because their eclampsia tended to occur late in gestation and was characterized by less retarded fetal growth. Older women and women with a history of abortion appeared to be of higher risk because they tended to have higher systolic pressures. A discriminant function risk formula is presented which generated groups with a nine-fold difference in fetal death rates. This formula could be used to standardize for relevant non-therapeutic factors which meant vary between patient groups who had received different therapeutic regimens.