Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia
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Abstract
Objective: Preeclampsia (PE) has been classified into early- and late-onset disease. These two phenotypic variants of PE have been proposed to have a different pathophysiology. However, the gestational age cut-off to define “early” vs. “late” PE has varied among studies. The objective of this investigation was to determine the prevalence of lesions consistent with maternal underperfusion of the placenta in patients with PE as a function of gestational age.
Study design: A nested case-control study of 8307 singleton pregnant women who deliver after 20 weeks of gestation was constructed based on a cohort. Cases were defined as those with PE (n=910); controls were pregnant women who did not have a hypertensive disorder in pregnancy (n=7397). The frequency of maternal underperfusion of the placenta (according to the criteria of the Society for Pediatric Pathology) was compared between the two groups. Logistic regression was used for analysis. Estimated relative risks (RRs) were calculated from odds ratios.
Results: 1) The prevalence of lesions consistent with maternal underperfusion was higher in patients with PE than in the control group [43.3% vs. 15.9%, unadjusted odds ratio 4.0 (95% CI 3.5–4.7); P<0.001]; 2) the estimated RR of maternal underperfusion lesions in PE was higher than in the control group [RR=2.8 (95% CI 2.5–3.0)]; 3) the lower the gestational age at delivery, the higher the RR for these lesions; 4) early-onset PE, regardless of the gestational age used to define it (<32, 33, 34, 35 or 37 weeks) had a significantly higher frequency of placental lesions consistent with maternal underperfusion than late-onset PE (P<0.001 for all).
Conclusions: 1) The earlier the gestational age of preeclampsia at delivery, the higher the frequency of placental lesions consistent with maternal underperfusion; 2) our data suggest that demonstrable placental involvement as determined by pathologic examination differs in early- and late-onset preeclampsia; and 3) this phenomenon appears to be a continuum, and we could not identify a clear and unambiguous gestational age at which lesions consistent with underperfusion would not be present.
©2011 by Walter de Gruyter Berlin Boston
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Articles in the same Issue
- Review Article
- Screening for pre-eclampsia: a systematic review of tests combining uterine artery Doppler with other markers
- Opinion Paper
- Reshaping pre-clerkship years in reproductive medicine education
- Original Articles – Obstetrics
- Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia
- The role of granulocyte colony-stimulating factor in the neutrophilia observed in the fetal inflammatory response syndrome
- Identification of high-risk patients for adverse pregnancy outcome based on multivariate logistic regression analysis at 20–23 gestational weeks
- Recurrence risks of hypertensive diseases in pregnancy after HELLP syndrome
- Procalcitonin levels during pregnancy, delivery and postpartum
- Determinants of folic acid use in a multi-ethnic population of pregnant women: a cross-sectional study
- Risk factors for emergent preterm delivery in women with placenta previa and ultrasound findings suspicious for placenta accreta
- Requests and usage of epidural analgesia in grand-grand multiparous and similar-aged women with lesser parity: prospective observational study
- Gene expression patterns of insulin-like growth factor 1, insulin-like growth factor 2 and insulin-like growth factor binding protein 3 in human placenta from pregnancies with intrauterine growth restriction
- Birth injury in a subsequent vaginal delivery among women with a history of shoulder dystocia
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- Nomogram of fetal upper arm volume by three-dimensional ultrasound using extended imaging virtual organ computer-aided analysis (XI VOCAL)
- Neonatal outcome using ultrathin fetoscope for laser coagulation in twin-to-twin-transfusion syndrome
- Original Articles – Newborn
- NICU admission hypothermia, chorioamnionitis, and cytokines
- Short Communication
- Risk factors associated with retained placenta after cesarean delivery
- Letters to the Editor
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- Aplasia cutis congenita due to methimazol exposure within the first trimester of pregnancy: case report
- Influence of umbilical cord abnormalities (velamentous/marginal cord insertion and nuchal cord) on the perinatal outcomes of the second twin after vaginal delivery of the first twin
- Comment on “Listeriosis in human pregnancy: a systematic review”
- Unexpected intrauterine fetal death in monochorionic-diamniotic twins near term
- Reply
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