ABSTRACT: Preeclampsia affects 5% to 7% of first pregnancies and recurs in 13% to 18% of subsequent pregnancies. Severe preeclampsia represents ∼25% of all cases of preeclampsia and is associated with high recurrence and maternal morbidity rates. Resolution of eclampsia occurs only with delivery and removal of functioning trophoblastic tissue. Accelerated recovery from the disease process following delivery could eliminate serious and life-threatening maternal complications and reduce intensive care unit and hospital stays. This prospective randomized controlled study was performed to determine the effect of immediate postpartum curettage on clinical and laboratory indices associated with preeclampsia and eclampsia.
The 420 women had a singleton pregnancy and severe preeclampsia or eclampsia. Severe preeclampsia was diagnosed when the blood pressure was 160/100 mm Hg or greater in 2 sessions of 6 or more hours apart, and significant proteinuria was present with or without associated fetal or maternal complications or significant laboratory changes. After either vaginal or cesarean delivery, 170 preeclamptic and 50 eclamptic women underwent immediate postpartum gentle curettage using blunt loop curette and including most of the surface area of the uterine cavity while patients were still under anesthesia. The 160 preeclamptic and 40 eclamptic control women did not undergo postpartum curettage. All patients were observed closely at 96 hours or longer after delivery.
Gestational ages ranged from 24 to 39 weeks in both groups, with mean ages of 31.5 ± 3.2 weeks in the curettage group and 30.9 ± 3.1 weeks in controls, not a significant difference. In the curettage group, 125 patients (58.1%) delivered by cesarean section, as did 130 women (65%) in the control group. Vaginal delivery occurred in 95 patients (43.2%) in the curettage group and 70 patients (35%) in the control group, with no difference between groups. The 2 groups did not differ significantly in clinical and laboratory prenatal parameters. Postnatally, the mean arterial blood pressure (MAP) and platelet counts were significantly improved in the curettage group over 6, 12, and 24 hours after delivery. The average time required for MAP to reach 105 mm Hg or less was 40 ± 3.15 hours in the curettage group compared with 86 ± 5.34 hours in the control group (P < 0.05). Adequate and higher urinary outputs in the postpartum period were noted in the curettage group but not reflected in serum creatinine values, which were 1.2 ± 0.20 and 1.3 ± 0.30 in curettage and control groups, respectively, at 48 hours postpartum. Two and 11 patients in the curettage and control groups, respectively (P = 0.02), had convulsions during the first 24 hours after delivery. No maternal deaths occurred in either group.
Uterine curettage in the immediate postpartum period had beneficial effects on MAP and platelet counts, leading to earlier recovery. Postpartum curettage is safe and effective, speeding recovery and decreasing complications and mortality associated with preeclampsia/eclampsia.
Department of Obstetrics/Gynecology, Mansoura University Hospitals (A.R., H.G., M.R., R.B., A.B.), and Department of Biochemistry, Mansoura Faculty of Medicine (A.E.-S.), Mansoura, Egypt