ABSTRACT
Background: Preeclampsia is being increasingly recognized as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset disease occurring at 34 or more weeks of gestation. Early-onset and late-onset pre-eclampsia are found to have different implications for the mother and neonate. The aim of this study is to compare the risk factors, maternal and fetal outcomes in early (<34 weeks) versus late (≥34weeks) onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Chettinad Academy of Research and Education over a period of three years (From January 2014 to December 2016) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on risk factors, maternal and fetal outcomes were collected and analyzed using Chi Square and Fisher’s test and compared.Results: The overall preeclampsia rate was 6.3%. Early onset and late onset were 34.6% and 65.3% respectively and the rate increased with increasing gestational age.35.3% of patients with late onset preeclampsia and 55.6% patients of early onset type required more than one drug which is a statistically significant difference. Proteinuria more than 3gm/l/day was significantly more in late onset preeclampsia than in early onset preeclampsia. 55.5% of patients with early onset pre-eclampsia required MgSO4 when compared to 17.4%. There was no statistically significant difference in the rate of caesarean section (61.1% vs 73.5%). Altered coagulation profile was significantly more in early onset preeclampsia (11.1%). The incidence of oligohydramnios, SGA and low APGAR at 5 minutes of birth were significantly high in early onset pre-eclampsia when compared to late onset type.Conclusions: Patients with early onset pre-eclampsia are found to have significantly higher rates of specific maternal and fetal morbidity when compared to the late onset type.
ABSTRACT
Introduction@#Preeclampsia remains to be a major cause of both fetal and maternal morbidity and mortality, particularly in severe forms leading to preterm birth. There is a lack of consensus, however, on the preferred screening test for early diagnosis with the aim of reducing the prevalence and morbidity of the disease. @*Objective@#To compare the performance of the comprehensive first trimester screening using maternal characteristics, ultrasonographic findings and serum biochemical markers, with the NICE and ACOG guidelines in predicting the development of preeclampsia. The study also aims to determine the compliance rate of clinicians in giving aspirin prophylaxis using the different screening tests. Methodology: This is a retrospective, analytical, cross sectional study of all pregnant patients between 11 to 13 6/7 weeks referred for comprehensive first trimester screening for preeclampsia from January 2014 to January 2018. Maternal factors were assessed to determine the risk of preeclampsia using NICE guidelines, ACOG guidelines and comprehensive first trimester screening. The compliance on aspirin administration for high-risk patients was also determined. The outcome measure was diagnosis of preeclampsia and the detection rate (DR) of the three screening tests were compared. @*Results@#A total of 202 women were included in the analysis where 24 (11.9%), 11 (5.4%) and 13 (6.4%) developed preeclampsia, early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE) respectively. The NICE and ACOG guidelines were able to detect preeclampsia with an accuracy of 76.73% (Sn 75%, Sp 77% PPV 30.5%) and 43.07% (Sn 83.3%, Sp 37.6% PPV 15.3%) respectively. The comprehensive first trimester screening was able to detect preeclampsia with an accuracy of 89.60% (Sn 83.3%, Sp 90.5% PPV 54.1%). EO-PE and LO-PE were detected with an accuracy of up to 97.2% using the comprehensive screening (Sn 90.9%, Sp 97.9% PPV 71.4%), compared with the NICE guideline (up to 74.26%, Sn 81.8%, Sp 73.8% PPV 15.3%) and the ACOG guideline (up to 39.6%, Sn 90.9%, Sp 36.6, PPV 7.63%). Compliance with the NICE and ACOG recommendation on aspirin administration was only 42.37% and 33.33%, respectively, and this increased to up to 62% when comprehensive first trimester screening was used. @*Conclusion@#This study confirmed that the performance of screening for PE, and therefore appropriate selection of the patients that would benefit from prophylactic use of aspirin and closer surveillance, is by far superior if the comprehensive first trimester screening is used than the method advocated by ACOG and NICE.
Subject(s)
Pre-Eclampsia , Pregnancy-Associated Plasma Protein-AABSTRACT
Las importantes diferencias que existen entre las manifestaciones de la preeclampsia, antes (inicio temprano) y después de la semana 34 (inicio tardío), plantean la posibilidad que se trate de dos enfermedades distintas. Basada en diferencias genéticas, epidemiológicas y placentarias, esta hipótesis cobra fuerza. Sin embargo, recientes estudios nos muestran la posibilidad de una continuidad clínico temporal entre ambos fenotipos. En este contexto los fenómenos antiangiogénicos y su relación con el feto podrían ser determinantes para esclarecer la interrogante.
Significant differences between preeclampsia manifestations before (early-onset) and after 34 weeks (late-onset) raise the possibility that these are two different diseases. This hypothesis is strengthened based on genetic, epidemiological and placental differences. However, recent studies show the possibility of temporal continuity between both clinical phenotypes. In this context antiangiogenic phenomena and their relation with the fetus may be crucial in clarifying this unanswered question.