Jurnal Reading

Pembimbing: dr. Ajeng Normala SpOG

Intan Wardani Nur Ali
406181074

Kepanitraan Koas Obgyn RSUD Ciawi

Periode 5 Agustus 2019-13 Oktober 2019
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 The Pulmonary Edema
Preeclampsia Evaluation
(PEPE) study
 BACKGROUND
Mortality from preeclampsia has decreased substantially in the last few decades
However, maternal and fetal morbidity remains high

Women with preeclampsia may develop pulmonary edema, but the reasons
for this are largely unknown

Common but under appreciated complication  pulmonary edema

In this study we explored potential risk factors for pulmonary edema in

women with preeclampsia.

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 METHODS
✘ Multicentre case control study of women with a diagnosis of preeclampsia during an index
hospitalization for delivery at two Toronto hospitals (Mount Sinai Hospital and
Sunnybrook Health Sciences Centre) between January 2005 and July 2012.
✘ Participants : each hospital’s medical records from all women who delivered a live born or
stillborn infant after 20 weeks gestation and confirmed by the onset in pregnancy of
✘ elevated blood pressure (systolic >140mmHg and/or a diastolic blood pressure >
90mmHg) and proteinuria of >= 1+ on dipstick or > 300 mg in a 24 hour urine collection.
✘ True Cases 28 : women who had pulmonary edema on a CT scan of chest or a plain
chest X-ray during the index hospitalization for delivery confirmed by the study coordinator
✘ Control subject 64 : women who confirmed Pre Eclampsia but no diagnosis of pulmonary
edema or heart failure in the index delivery hospitalization

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 METHODS
Variables :
Demographic details, past medical history, pre-pregnancy height and weight, and
use of an antrihypertensive medication in the current pregnancy
Obstretical data, multi-fetal pregnancy, mode of delivery, gestational age at
delivery, and maternal receipt of magnesium sulphate for fetal prematurity or
corticosteroids for fetal lung maturity.
 RESULTS
92 women with preeclampsia :
28 had pulmonary edema (cases)
64 didn’t have pulmonary edema
(control subjects)
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 RESULTS
1. Use of antihypertensive medication at the index admission for delivery
did not reach significance for pulmonary edema
2. Each reduction in the minimum platelet count or increase in the peak
serum uric acid concentration was significantly associated with
pulmonary edema

3. Receipt of magnesium sulphate for eclampsia prevention or fetal

neuroprotection was significantly associated with pulmonary edema.
4. Multiparity was associated with a lower risk of developing pulmonary
edema
5. Each 500 mL increase in the volume of intravenous crystalloids received
was also associated with a lower risk of pulmonary edema.
6. Receipt of any blood product was not associated with pulmonary edema.
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DISCUSSION

✘ Higher risk of pulmonary edema:

✗ Lower platelet count
✗ Higher serum uric acid concentration
✗ Receipt of magnesium sulphate
 DISCUSSION

✘ Lower risk of pulmonary edema

✗ Multiparity
✗ 500 mL increase in the volume of
intravenous crystalloids

✘ Nulliparity  associated with a near trippling

of the risk of preeclampsia

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CONCLUSION
✘ This case control study offers a preliminary understanding of some
risk factors for development of pulmonary edema in the setting
of preeclampsia.
✘ Additional work Is required to validate the importance of ….. In the
development of pulmonary edema
✗ Nulliparity
✗ Declining platelet count
✗ High serum uric acid concentration
✗ Receipt of intravenous magnesium sulphate
.