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Birth weight, Apgar score, and fetal complications in mothers with severe preeclampsia
Heldayanti Sirendena, Isharyah Sunarnob,
Corresponding author
, M. Aryadi Arsyada, Irfan Idrisc
a Department of Midwifery, Graduate School, Hasanuddin University, Indonesia
b Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Indonesia
c Department of Physiology, Faculty of Medicine, Hasanuddin University, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Preeclampsia &#40;PE&#41; occurs in 2&#8211;8&#37; of pregnancies and is an indicator of maternal and child health because it is one of the factors causing maternal and perinatal death&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">1&#44;2</span></a> Severe preeclampsia &#40;SPE&#41; is characterized by blood pressure &#8805;160&#47;110<span class="elsevierStyleHsp" style=""></span>mmHg at gestational age<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>20 weeks and urine dipstick test showing urine protein &#8805;&#43;2&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a> The exact cause of preeclampsia is still unknown certainly&#44; but several studies have shown that endothelial dysfunction&#44; placental dysfunction&#44; and systemic inflammation during pregnancy involve in the pathogenesis of preeclampsia&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Severe preeclampsia is one of the leading causes of maternal death and is associated with 8-fold increased risk of developing preeclampsia with maternal severe complications&#44; such as HELLP syndrome&#44; pulmonary edema&#44; Disseminated Intravascular Coagulopathy &#40;DIC&#41;&#44; acute renal failure&#44; and abruption placenta&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6&#44;7</span></a> Perinatal complications such as low birth weight&#44; low Apgar Score&#44; Intra Uterine Fetal Death &#40;IUFD&#41;&#44; Intra Uterine Growth Restriction &#40;IUGR&#41;&#44; premature birth&#44; and abortion are complications that can occur due to severe preeclampsia&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6&#44;8</span></a> The condition of increased blood pressure during pregnancy accompanied by other problems such as anemia also has the potential to cause stunting in infants&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Therefore&#44; the purpose of this study was to find out the birth weight and the Apgar score of newborns and fetal complications that occur in the group of severe preeclampsia and severe preeclampsia with other maternal complications&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research was descriptive retrospective research using medical records&#46; The sample of this research was the delivering mothers who have been diagnosed with severe preeclampsia during the period of 1 January 2017&#8211;May 2019 in four hospitals in Makasar&#58; the Provincial Public Hospital Dr&#46; Wahidin Sudirohusodo &#40;206 cases&#41;&#44; the State Higher Education Hospital of Hasanuddin University &#40;16 cases&#41;&#44; the District Hospital Special for Mothers and Children of Pertiwi &#40;54 cases&#41;&#44; and the Mothers and Children Hospital of Sitti Khadijah 3 &#40;28 Case&#41;&#46; The study was conducted after obtaining a research ethics permission issued by the ethics committee of the medical faculty of Hasanuddin University&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The restrictive criteria were mothers who had chronic hypertension&#44; multiple pregnancies&#44; a history of diabetes&#44; cardiovascular disorders&#44; premature rupture of membranes&#44; and also some medical records that did not have complete data&#46; In our study&#44; we divided pregnant women into two groups&#44; those with severe preeclampsia and those with severe preeclampsia with maternal complications such as eclampsia&#44; HELLP syndrome&#44; acute renal impairment&#44; pulmonary edema&#44; Disseminated Intravascular Coagulopathy &#40;DIC&#41;&#44; and placental abruption&#46; The foundation of the diagnosis was based on the results of the final diagnosis listed in the medical record&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The perinatal outcome&#44; birthweight&#44; was grouped into meager birth weight &#40;&#60;1000<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; meager birth weight &#40;1000&#8211;1499<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; low birth weight &#40;1500&#8211;2499<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; normal weight &#40;2500&#8211;4000<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; and high birth weight &#40;&#62;4000<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; Moreover&#44; the Apgar score assessment was taken in the first and fifth minutes after birth and fetal complications during pregnancy&#46; Data were analyzed using chi-square statistic test&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0035" class="elsevierStylePara elsevierViewall">There were 256 pregnant women who met the criteria of this study&#44; 184 &#40;71&#46;9&#37;&#41; were severe preeclampsia&#44; and 92 &#40;28&#46;1&#37;&#41; were severe preeclampsia with maternal complications&#46; There were no significant differences in the age and parity characteristics in the two groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Most of the samples are aged 20&#8211;35 years with multipara status&#46; There is a significant difference between PEB and PEB with maternal complications in gestational age on delivery &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41; and method of delivery &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;030&#41;&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">There were significant differences in birth weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#41;&#44; Apgar score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; and fetal complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#41;&#46; In the severe preeclampsia group&#44; 54&#46;3&#37; of infants were born having 2500&#8211;4000 body weight and Apgar scores of 7&#8211;10 in the first minute &#40;72&#46;8&#41; and 5<span class="elsevierStyleHsp" style=""></span>min &#40;83&#46;7&#41;&#46; Low birth weight was more common in the severe preeclampsia group with maternal complications &#40;37&#46;5&#37;&#41;&#44; and the Apgar score in the first minute &#40;47&#46;2&#37;&#41; and fifth &#40;68&#46;1&#37;&#41; was 7&#8211;10&#46; 43&#46;7&#37; of fetal complications occurred in the group of severe preeclampsia with complications &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study found significant differences in gestational age on delivery&#44; birth weight&#44; Apgar score&#44; and fetal complications between the group of severe preeclampsia and severe preeclampsia with complications&#46; In preterm delivery &#40;gestational age<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>37 weeks&#41; occurs mostly in the severe preeclampsia group with maternal complications while in the severe preeclampsia group without complications group the majority is &#8805;37 weeks&#46; Patients with preeclampsia are advised for medical iatrogenic delivery before 37 weeks of gestational age because early delivery is an effective treatment that can be used in patients with hypertension in pregnancy&#46; This can iatrogenic medical from the cesarean delivery which is the most common type of Apgar in the group of severe preeclampsia and severe preeclampsia with complications &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; However&#44; if there are no signs of serious maternal complications or poor fetal conditions&#44; it is advisable to postpone delivery when preeclampsia cesarean before 37 weeks of gestational age&#46; This is to improve neonatal outcomes without endangering the health of the mother and fetus&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">10&#8211;12</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In the severe preeclampsia group with complications&#44; most infants were classified as low birth weight &#40;40&#46;3&#37;&#41;&#46; This low birth weight is related to the high number of preterm deliveries in the preeclampsia group with complications&#46; This is because gestational age directly affects fetal weight&#44; so preterm delivery in severe preeclampsia with complications&#44; in general&#44; will affect the birth of a low birth weight baby&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In this study&#44; there is a relationship between Apgar score and severe preeclampsia&#46; The highest number of first and fifth-minute scores is 7&#8211;10&#44; but in severe preeclampsia with complications&#44; the first-minute scores are 0&#8211;3 &#40;30&#46;6&#37;&#41; and 4&#8211;6 &#40;22&#46;2&#37;&#41;&#46; The results are similar with the results of a study&#44; it is finding an association between asphyxia &#40;Apgar score<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7&#41; with severe preeclampsia accompanied by HELLP syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In the group of severe preeclampsia with complications&#44; 41&#46;7&#37; perinatal had complications since in the womb such as fetal distress&#44; Intra-Uterine Growth Restriction &#40;IUGR&#41;&#44; and Intra-Uterine Fetal Death &#40;IUFD&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46; A study also found that pregnant women with severe preeclampsia with complications are four times more at risk of getting poor perinatal outcomes compared with women without complications&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> Fetal death also increased 4-fold in mothers with preeclampsia compared to normal mothers&#44; and this risk increases exponentially in those with eclampsia&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The incidence of preterm birth&#44; low birth weight&#44; and fetal complications are more common in the group of severe preeclampsia with complications&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Preeclampsia is one of the factors causing maternal and perinatal death&#46; The purpose of this study was to find out the birth weight and the Apgar score of the newborn in correlation with fetal complications in mothers with severe preeclampsia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study was a descriptive retrospective study by reviewing the medical records of pregnant women who have been diagnosed with severe preeclampsia during the period of January 2017&#8211;May 2019&#46; The study was conducted in 4 hospitals in Makassar&#46; Data were statistically analyzed using the chi-square test&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 256 pregnant women who met the criteria of this study&#44; 184 &#40;71&#46;9&#37;&#41; suffered severe preeclampsia&#44; and 92 &#40;28&#46;1&#37;&#41; suffered severe preeclampsia with maternal complications&#46; The patients with severe preeclampsia were mostly in age of 20&#8211;35 years old &#40;59&#46;2&#37;&#41;&#44; multiparous &#40;69&#46;6&#37;&#41;&#44; with gestational age on delivery<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>37 weeks &#40;56&#37;&#41; while In the severe preeclampsia with maternal complications group&#44; most women were in age of 20&#8211;35 &#40;69&#46;4&#37;&#41;&#44; multiparous &#40;73&#46;6&#37;&#41;&#44; with preterm delivery &#40;65&#46;3&#37;&#41;&#46; Low birth weight was found more in the severe preeclampsia with maternal complications group &#40;37&#46;5&#37;&#41;&#46; The APGAR score of 7&#8211;10 in the first and fifth minutes was high in both groups&#46; 41&#46;7&#37; of fetal complications occurred in the group of severe preeclampsia with complications&#46; There are significant differences in gestational age on delivery&#44; birth weight&#44; Apgar score and fetal complications in the group of severe preeclampsia and severe preeclampsia with complications &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The incidence of preterm birth&#44; low birth weight&#44; and fetal complications are more common in the group of severe preeclampsia with complications&#46;</p></span>"
        "secciones" => array:4 [
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on Quality of Life &#40;WOSQUAL-2019&#41;&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
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                  \t\t\t\t" scope="col">Maternal characteristics&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Severe preeclampsia with maternal complications &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>72&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primipara&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No Complications&nbsp;\t\t\t\t\t\t\n
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                0 => "xTab3173617.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Infant birth weight&#44; Apgar score&#44; and fetal complications in severe preeclampsia and severe preeclampsia with maternal complications&#46;</p>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:16 [
            0 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preeclampsia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;G&#46;L&#46; Ramos"
                            1 => "N&#46; Sass"
                            2 => "S&#46; Hofmeister"
                            3 => "M&#46; Costa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-0037-1604471"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Bras Ginecol Obstet"
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        "texto" => "<p id="par0075" class="elsevierStylePara elsevierViewall">We thank the Provincial General Hospital of Dr&#46; Wahidin Sudirohusodo&#44; the State Higher Education Hospital of Hasanuddin University&#44; the District Hospital Special for Mothers and Children of Pertiwi&#44; and the Hospital of Sitti Khadijah 3 in Makassar that have given permission and assisted in conducting this research&#46;</p>"
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Original language: English
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