Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist

. 2016 May 13;4(2):26. doi: 10.3390/healthcare4020026

(D) Outcome measures.

Maternal Outcome Measures	Perinatal Outcome Measures
□ Maternal death □ Hepatic failure □ hepatic hematoma □ hepatic rupture □ Glasgow coma score < 13 □ Stroke	□ Stillbirth □ Neonatal death □ Infant death
□ Two or more seizures □ Cortical blindness □ Positive inotrope support □ Myocardial infarction □ Third intravenous antihypertensive used □ Renal dialysis □ Renal transplantation □ 50% FIO2 for >1 h □ Pulmonary edema □ Pneumonia □ Intubation □ Postpartum hemorrhage. If checked choose: □ Medically managed □ Balloon tamponade □ Dilation and curettage □ Hysterectomy □ Uterine artery embolization □ Transfusion of 10 or more units of blood Products □ Intensive care unit admission Record highest BP mm Hg in first 24 h of admission: Systolic BP: _______ Diastolic BP:_______ Pulse pressure:_______ Mean arterial pressure:_______ Record history urine protein in first 24 h of admission: _______grams Record highest Aspartate transaminase in first 24 h of admission: ________ Record lowest platelet count in first 24 h of admission: ________ × 10⁹/L □ Cesarean delivery. If checked choose all that apply for anesthesia: □ Spinal □ Epidural □ General □ Vaginal delivery □ Labor induction □ Length of labor □ Length of hospitalization	□ Bronchopulmonary dysplasia □ Necrotizing enterocolitis □ Grade III/IV intraventricular hemorrhage □ Cystic periventricular leukomalacia □ Stage 3–5 retinopathy of prematurity □ In special care nursery for more than 10 days: Record the number of days: ______days Record gestational age at delivery: _____weeks Record birth weight: _______grams □ Small for gestational age Record birth weight percentile _____ Record 0, 1, 5, and 10 min APGAR score _______, _______, ________, _______

Maternal Outcome Measures

Perinatal Outcome Measures

□ Maternal death
□ Hepatic failure □ hepatic hematoma □ hepatic rupture
□ Glasgow coma score < 13 □ Stroke

□ Stillbirth
□ Neonatal death
□ Infant death

□ Two or more seizures
□ Cortical blindness
□ Positive inotrope support
□ Myocardial infarction
□ Third intravenous antihypertensive used
□ Renal dialysis □ Renal transplantation
□ 50% FIO2 for >1 h □ Pulmonary edema
□ Pneumonia □ Intubation
□ Postpartum hemorrhage. If checked choose:
□ Medically managed □ Balloon tamponade
□ Dilation and curettage □ Hysterectomy
□ Uterine artery embolization
□ Transfusion of 10 or more units of blood
Products
□ Intensive care unit admission
Record highest BP mm Hg in first 24 h of admission:
Systolic BP: _______
Diastolic BP:_______
Pulse pressure:_______
Mean arterial pressure:_______
Record history urine protein in first 24 h of admission: _______grams
Record highest Aspartate transaminase in first 24 h of admission: ________
Record lowest platelet count in first 24 h of admission: ________ × 10⁹/L
□ Cesarean delivery. If checked choose all that apply for anesthesia:
□ Spinal □ Epidural □ General
□ Vaginal delivery
□ Labor induction
□ Length of labor
□ Length of hospitalization

□ Bronchopulmonary dysplasia
□ Necrotizing enterocolitis
□ Grade III/IV intraventricular hemorrhage
□ Cystic periventricular leukomalacia
□ Stage 3–5 retinopathy of prematurity
□ In special care nursery for more than 10 days:
Record the number of days: ______days
Record gestational age at delivery: _____weeks
Record birth weight: _______grams
□ Small for gestational age
Record birth weight percentile _____
Record 0, 1, 5, and 10 min APGAR score
_______, _______, ________, _______

im = intramuscular; iv = intravenous; BP = blood pressure; PE-E blood tests = Complete blood count (CBC), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen, comprehensive metabolic panel (CMP), and uric acid; PE-E urine tests = Congo red dot, and/or spot urine protein/creatinine ratio, or 24 h total urine protein and creatinine clearance; PPD = Post-delivery day.