Clicical Analysis Of91Cases Of Severe Pre-eclampsia Complicated By Ascites

ObjectiveTo analyse the clinical feature of severe pre-eclampsia pregnancies complicated by ascites, and to discuss the treatment, especially with albumin treatment and diuresis therapy.Materials and MethodsThe clinical data of91patients with severe pre-eclampsia complicated by ascites were reviewed retrospectively, who are admitted between January2010and July2011in Qilu Hospital.ResultsBaseline characteristics were compared between patients. The median gestational age was33+2weeks when they develop the disease, and the mean volume of ascites is about1164.2ml.Patients with gestational age≤28weeks have much more ascites than other groups, and decreased for the late onset severe preeclampsia. The mean level of plasma albumin before labor is25.6±3.6g/L, and23.6±3.5g/L after labor,both with reversed ratio of albumin to globulin. No statistically differences of plasma albumin level were found but only in the group with gestational age between28-30weeks, and no correlation is found between plasma albumin level prenatal with the volume of ascites. The level of urine protein are all between++～++++, with8patients≥++++and22patients (24.2%)≥+++. The mean level of24hour urinary protein quantity is11.6±8.4g. No correlation is found between the24hour urinary protein quantity and the protein level of urine or plasma, but only with the volume of ascites. The mean level of LDH is447.3±262.4U/L,which has no correlation with ascites volume. The differential level of LDH between early group and late group may be the specific biomarkers.81patients (89%) received albumin and diuresis therapy, and the mean dosage of albumin used is44.1±41.0g. A trend towards less usage of albumin and later onset of severe pre-eclampsia is observed. The mean expectant management time of the treatment group is8.8±6.9days, much longer than the matched group (1.4±2.1); the mean volume of ascites is1820.7±1369.8ml in the treatment group,much more than the matched group(1035.7±1160.6ml), both with statistically differences. No significant differences are found of the newborn Apgar score, perinatal mortality, the rate of maternal complications and cesarean section rate between two groups. The mean expectant time is6.8±6.2days, and11patients received timely treatment once they were admitted.79patients gave birth to children with premature birth rate of87.3%and cesarean rate of86.8%. The mean length of stay after labor is5-7days with7.75%of blood pressure down to normal.ConclusionThe condition of patients with severe pre-eclampsia complicated by ascites is extremely serious, especially for the one with early onset severe pre-eclampsia and should receive special attention. The expectant management should be monitored carefully. Additional use of albumin combined with furosemide do work in extending gestational age without increasing the rate of maternal complications. It is the mostly important for terminate pregnancy in time, continuous clinical monitoring to reduce the rate of maternal complications.