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Prediction of adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of pregnancy: A systematic review.

TitlePrediction of adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of pregnancy: A systematic review.
Publication TypeJournal Article
Year of Publication2018
AuthorsUkah, V, De Silva, D, Payne, BA, Magee, LA, Hutcheon, J, Brown, H, Ansermino, JM, Lee, T, von Dadelszen, P
JournalPregnancy Hypertens
Volume11
Pagination115-123
Date Published2018 Jan
ISSN2210-7797
KeywordsAdult, Area Under Curve, Female, Humans, Hypertension, Pregnancy-Induced, Maternal Mortality, Multivariate Analysis, Pre-Eclampsia, Predictive Value of Tests, Pregnancy, Prognosis, Risk Assessment, Risk Factors, ROC Curve, Young Adult
Abstract

BACKGROUND: The hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity. The ability to predict these complications using simple tests could aid in management and improve outcomes. We aimed to systematically review studies that reported on potential predictors of adverse maternal outcomes among women with a hypertensive disorder of pregnancy.

METHODS: We searched MEDLINE, Embase and CINAHL (inception - December 2016) for studies of predictors of severe maternal complications among women with a hypertensive disorder of pregnancy. Studies were selected in a two-stage process by two independent reviewers, excluding those reporting only on adverse fetal outcomes. We extracted data on study and test(s) characteristics and outcomes. Accuracy of prediction was assessed using sensitivity, specificity, likelihood ratios and area under the receiver operating curve (AUROC). Strong evidence of prediction was taken to be a positive likelihood ratio >10 or a negative likelihood ratio <0.1, and for multivariable models, an AUROC ≥0.70. Bivariate random effects models were used to summarise performance when possible.

RESULTS: Of 32 studies included, 28 presented only model development and four examined external validation. Tests included symptoms and signs, laboratory tests and biomarkers. No single test was a strong independent predictor of outcome. The most promising prediction was with multivariable models, especially when oxygen saturation, or chest pain/dyspnea were included.

CONCLUSION: Future studies should investigate combinations of tests in multivariable models (rather than single predictors) to improve identification of women at high risk of adverse outcomes in the setting of the hypertensive disorders of pregnancy.

DOI10.1016/j.preghy.2017.11.006
Alternate JournalPregnancy Hypertens
Citation Key615
PubMed ID29198742