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Maternal acid-base disorders: clinical predictors of the requirement for urgent delivery in late onset severe preeclampsia
Abstract Number: S2A-2
Abstract Type: Original Research
Preeclampsia (PreE) remains a leading cause of maternal and neonatal mortality and morbidity worldwide, and in severe disease delivery is usually expedited to avoid complications or further progression of the disease. A pilot study found significant abnormalities in independent acid-base (AB) determinants and an association with delivery outcome1. The aim of this analysis was to determine the association between maternal AB abnormalities and the need for urgent cesarean delivery (CD) for fetal or maternal indications.
This was a planned secondary analysis of a large observational study of point-of-care ultrasound in 95 women with late onset severe PreE (NCT#02721771). Maternal venous blood was sampled for AB analysis based on the physico-chemical approach (Stewart-Gilfix method)2,3. AB sampling was performed at the time of diagnosis and before induction of labor (IOL). A comparison was made between Stewart-parameters from historical healthy pregnant controls (HPC) matched with respect to gestational age. A descriptive and univariate regression analysis were performed to examine the association between the Stewart-parameters and an abnormal fetal heart tracing (CTG) and/or urgent CD for either a fetal or maternal indication.
IOL was performed in 83 women, of which 27 underwent urgent CD for fetal indications and 7 for maternal indications. AB analysis revealed a metabolically compensated respiratory alkalosis resulting in normal range pH in HPC and severe PreE (Table 1). While overall pH and BE were similar in both groups, Stewart analysis revealed hypoalbuminaemic alkalosis offset by hyperchloremic acidosis in severe PreE. BE(Alb) and BE(Lac) were associated with the development of category II or III CTG (OR 1.3 and 0.9, respectively, p<0.05) and urgent CD based on fetal indications (OR 1.5 (95%CI:1.1-2.0), p=0.01) and 0.4 (95%CI:0.2-0.6), p=0.001), respectively). Serum lactate at diagnosis was further associated with urgent CD for maternal indications (OR=0.5 (95%CI:0.3-0.8), p<0.01).
Women diagnosed with late onset severe PreE exhibited compensated AB-status. Analysing contributors to BE showed hypoalbuminemic alkalosis offset by hyperchloremic acidosis. Serum lactate, albumin and BE (Alb) might be useful markers of disease severity, and are potential predictors of the requirement for urgent CD.
1. Ortner C, BJA 2015
2. Stewart P, Can J Physiol Pharmacol 1983
3. Gilfix B, J Crit Care 1993