Definitions
PE was defined by the presence of de novo hypertension (systolic blood
pressure (BP) > 140 mmHg and/or diastolic BP> 90 mmHg measured on two occasions at least 4 hours
apart) after 20 weeks of gestation accompanied by proteinuria
(> 300 mg/24h or a urine protein/creatinine ratio
> 0.3 mg/mmol)(20). Early-onset cases were considered when
admission occurred before 34 weeks of gestation. Gestational age was
calculated according to the crown-rump length at first-trimester
ultrasound scan (21). Severe features were defined according the
American College of Obstetricians and Gynecologists as: systolic BP> 160 mmHg or diastolic BP > 110
mmHg on two occasions at least 4 hours apart, thrombocytopenia
(<100x109/L platelets), impaired liver
function (blood concentrations of liver enzymes to twice normal and/or
severe persistent right upper quadrant or epigastric pain unresponsive
to medication and not accounted for by alternative diagnoses), renal
insufficiency (serum creatinine concentration greater than 1.1 mg/dl in
absence of other renal disease), pulmonary edema or new-onset cerebral
or visual disturbances (22).
At admission, the risk for complications was estimated according to the
Prediction of complications in Early-onset-Preeclampsia (PREP-L) score
(12,23), which includes maternal age, gestational age, preexisting
medical conditions, protein-to-creatinine ratio, serum urea
concentration, platelet count, systolic blood pressure, need for
antihypertensive treatment or magnesium sulphate.
Maternal complications were defined as: (i) HELLP syndrome (lactate
dehydrogenase [LDH] >600 IU/L, AST to twice normal
values and platelet count <100x109/L); (ii)
Central nervous system dysfunction (eclampsia, Glasgow Coma Score
<13 (24), stroke, reversible ischemic neurological deficit or
cortical blindness); (iii) hepatic dysfunction (INR >1.2 in
the absence of disseminated intravascular coagulation, MELD score> 10 (25,26) or hepatic hematoma or rupture); (iv)
renal dysfunction (dialysis, serum creatinine concentration greater than
150 µmol/L or urine output <0.5 ml/kg/h during 12 hours,
according to renal insufficiency by RIFLE criteria (27); or need for
treatment with furosemide to maintain urine output
>0.5ml/kg/h for 3 hours); (v) respiratory dysfunction
(pulmonary edema, requirement of invasive or non-invasive mechanical
ventilation, oxygen requirement greater than 50% concentration for
longer than 1 hour or severe breathing difficulty [no criteria of
pulmonary edema but presence of dyspnea, crackles in pulmonary
auscultation and SaO2<90%]); and/or (vi)
cardiovascular dysfunction (need for inotropic support, left ventricle
failure or myocardial infarction); (vii) critical hypertension
(requirement for three or more different antihypertensive treatments to
control BP).
Fetal growth restriction (FGR) was defined according to the Delphi
consensus for early-onset form (28).