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Cagino KA, Trotter RD, Lambert KE, Kumar SC, Sibai BM. Expectant management of preeclampsia with severe features diagnosed at less than 24 weeks. Am J Obstet Gynecol 2024:S0002-9378(24)00557-X. [PMID: 38697342 DOI: 10.1016/j.ajog.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND The recent American College of Obstetricians and Gynecologists Practice Bulletin offers no guidance on the management of preeclampsia with severe features at <24 weeks of gestation. Historically, immediate delivery was recommended because of poor perinatal outcomes and high maternal morbidity. Recently, advances in neonatal resuscitation have led to increased survival at periviable gestational ages. OBJECTIVE This study aimed to report perinatal and maternal outcomes after expectant management of preeclampsia with severe features at <24 weeks of gestation. STUDY DESIGN This was a retrospective case series of preeclampsia with severe features at <24 weeks of gestation at a level 4 center between 2017 and 2023. Individuals requiring delivery within 24 hours of diagnosis were excluded. Perinatal and maternal outcomes were analyzed. Categorical variables from our database were compared with previously published data using chi-square tests. RESULTS A total of 41 individuals were diagnosed with preeclampsia with severe features at <24 weeks of gestation. After the exclusion of delivery within 24 hours, 30 individuals (73%) were evaluated. The median gestational age at diagnosis was 22 weeks (interquartile range, 22-23). Moreover, 16% of individuals had assisted reproductive technology, 27% of individuals had chronic hypertension, 13% of individuals had pregestational diabetes mellitus, 30% of individuals had previous preeclampsia, and 73% of individuals had a body mass index of >30 kg/m2. The median latency periods at 22 and 23 weeks of gestation were 7 days (interquartile range, 4-23) and 8 days (interquartile range, 4-13). In preeclampsia with severe features, neonatal survival rates were 44% (95% confidence interval, 3%-85%) at 22 weeks of gestation and 29% (95% confidence interval, 1%-56%) at 23 weeks of gestation. There were 2 cases of acute kidney injury (7%) and 2 cases of pericardial or pleural effusions (7%). Overall perinatal survival at <24 weeks of gestation was 30% in our current study vs 7% in previous reports (P=.02). CONCLUSION For cases of expectant management of preeclampsia with severe features at <24 weeks of gestation, our findings showed an increased perinatal survival rate with decreased maternal morbidity compared with previously published data. This information may be used when counseling on expectant management of preeclampsia with severe features at <24 weeks of gestation.
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Affiliation(s)
- Kristen A Cagino
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX.
| | - Rylee D Trotter
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Katherine E Lambert
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Saloni C Kumar
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
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Ren J, Zhao C, Fan Z, Wang Y, Sheng H, Hua S. The interval between the onset of increased blood pressure and proteinuria in preeclampsia and the contributing factors. Arch Gynecol Obstet 2023:10.1007/s00404-023-07284-2. [PMID: 38133812 DOI: 10.1007/s00404-023-07284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 10/28/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE New-onset proteinuria, as a pivotal sign of representative renal lesions in preeclampsia, is still the most common diagnostic tool for this condition and has been proven to be related to a significantly abnormal sFlt-1/VEGF ratio in circulation. At the same time, blood pressure control plays a vital role in the occurrence and evolution of proteinuria. Therefore, it is particularly helpful to investigate their interval, not only for performing urinalysis for protein more accurately but also for evaluating blood pressure as well as the aggravation of illness, as the related research is limited. METHODS This retrospective study included 515 preeclampsia patients and 358 normotensive pregnant women who labored in the Second Hospital of Tianjin Medical University from January 2016 to January 2020. First, we described the onset circumstance of high blood pressure and proteinuria as well as the interval among the case group and the subgroups. Then, we determined whether there were significant differences in the basic information, laboratory test results, and newborns between the case and normal groups. Finally, multifactor ANOVA was used to determine the factors influencing the interval. RESULTS 1. The two most common complications in preeclampsia were proteinuria (88.35%) and placental dysfunction (5.05%). Moreover, 72.04% of preeclampsia cases were diagnosed by abnormal blood pressure together with new-onset proteinuria. 2. The average interval between high blood pressure and proteinuria was 22 gestational days (from 0 to 106 days), and this interval was not significantly different between mild and severe PE (26 days vs. 21 days, P > 0.05) but significantly differed between early-onset and late-onset PE (9 days vs. 28 days, P < 0.05). 3. The number of prenatal visits, serum creatinine in the early trimester, gestational time and diastolic blood pressure value when increased blood pressure was initially detected may influence the interval between the onset of increased blood pressure and proteinuria. CONCLUSION New-onset proteinuria was still the main parameter for identifying preeclampsia. The interval between increased blood pressure and proteinuria was probably related to the imbalance in the sFlt-1/VEGF ratio; therefore, we should pay attention to monitor proteinuria during the prenatal visits, especially for patients with a lower frequency of prenatal visits, higher serum creatinine in the early trimester, earlier onset and higher diastolic blood pressure at the initial onset of increased blood pressure.
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Affiliation(s)
- Jie Ren
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Caiyun Zhao
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Zhuoran Fan
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Yanli Wang
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Hongna Sheng
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China
| | - Shaofang Hua
- Obstetrics Department, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Tianjin, 300211, China.
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Cozzi GD, Blanchard CT, Sanjanwala AR, Page MR, Kim DJ, Tita AT, Szychowski JM, Subramaniam A. Defining a Strategy for Laboratory Evaluation with Expectant Management of Preeclampsia. Am J Perinatol 2023; 40:1704-1714. [PMID: 34784612 DOI: 10.1055/s-0041-1739511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of this study was to compare the frequency and timing of laboratory abnormalities and evaluate optimal laboratory testing strategies in women with preeclampsia (PE) undergoing expectant management. STUDY DESIGN Retrospective cohort study of women with inpatient expectant management of PE at ≥23 weeks at a tertiary center from 2015 to 2018 was conducted. Women ineligible for expectant management or with less than two laboratory sets (platelets, aspartate aminotransferase, and serum creatinine) before the decision to deliver were excluded. Women were categorized as per the American College of Obstetricians and Gynecologists' definitions by initial diagnosis: PE without severe features, superimposed preeclampsia (SiPE) without severe features, and their forms with severe features. The frequency and timing of laboratory abnormalities were compared across the four PE categories. Kaplan-Meier curves modeled time to a laboratory abnormality (event) with censoring for delivery and were compared using log-rank tests. Logistic regression analysis modeled the development of a laboratory abnormality as a function of testing time intervals (days) for each PE type. Receiver operating characteristic curves and areas under the curve (AUC) were calculated; optimal cut points were determined using the Liu method. RESULTS Among 636 women who met inclusion criteria, laboratory abnormalities were uncommon (6.3%). The median time to a laboratory abnormality among all women was ≤10 days, time being shortest in women with PE with severe features. Time to laboratory abnormality development did not differ significantly between the four PE groups (p = 0.36). Laboratory assessment intervals were most predictive for PE and SiPE with severe features (AUC = 0.87, AUC = 0.72). Optimal cutoffs were every 4 days for PE without severe features, 2 days for PE with severe features, 8 days for SiPE without severe features, and 3 days for SiPE with severe features. CONCLUSION Most laboratory abnormalities in PE occur earlier and more frequently in those with severe features. Individual phenotypes should undergo serial evaluation based on this risk stratification. KEY POINTS · Most laboratory abnormalities occur within 10 days of diagnosis.. · Laboratory abnormalities occur more often with severe features.. · Laboratory testing should occur according to disease severity..
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Affiliation(s)
- Gabriella D Cozzi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina T Blanchard
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aalok R Sanjanwala
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret R Page
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dhong-Jin Kim
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Akila Subramaniam
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, von Dadelszen P, Helewa M, Rey E. Directive clinique n o 426 : Troubles hypertensifs de la grossesse : Diagnostic, prédiction, prévention et prise en charge. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:572-597.e1. [PMID: 35577427 DOI: 10.1016/j.jogc.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIF La présente directive a été élaborée par des fournisseurs de soins de maternité en obstétrique et en médecine interne. Elle aborde le diagnostic, l'évaluation et la prise en charge des troubles hypertensifs de la grossesse, la prédiction et la prévention de la prééclampsie ainsi que les soins post-partum des femmes avec antécédent de trouble hypertensif de la grossesse. POPULATION CIBLE Femmes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en œuvre des recommandations de la présente directive devrait réduire l'incidence des troubles hypertensifs de la grossesse, en particulier la prééclampsie, et des issues défavorables associées. DONNéES PROBANTES: La revue exhaustive de la littérature a été mise à jour en tenant compte des nouvelles données probantes jusqu'en décembre 2020 et en suivant la même méthodologie que pour la précédente directive de la Société des obstétriciens et gynécologues du Canada (SOGC) sur les troubles hypertensifs de la grossesse. La recherche s'est limitée aux articles publiés en anglais ou en français. Les recommandations relatives aux traitements s'appuient d'abord sur les essais cliniques randomisés et les revues systématiques (lorsque disponibles), ainsi que sur l'évaluation des résultats cliniques substantiels chez les mères et les bébés. MéTHODES DE VALIDATION: Les auteurs se sont entendus sur le contenu et les recommandations par consensus et ont répondu à l'examen par les pairs du comité de médecine fœto-maternelle de la SOGC. Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE) et se sont gardé l'option de désigner certaines recommandations par la mention « bonne pratique ». Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). Le conseil d'administration de la SOGC a approuvé la version définitive aux fins de publication. PROFESSIONNELS CIBLES Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières et anesthésistes) qui prodiguent des soins aux femmes avant, pendant ou après la grossesse. RECOMMANDATIONS
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Jaber S, Jauk VC, Cozzi GD, Sanjanwala AR, Becker DA, Harper LM, Casey BM, Sinkey RG, Subramaniam A. Quantifying the additional maternal morbidity in women with preeclampsia with severe features in whom immediate delivery is recommended. Am J Obstet Gynecol MFM 2022; 4:100565. [PMID: 35033750 DOI: 10.1016/j.ajogmf.2022.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preeclampsia with severe features when diagnosed at less than 34 weeks is associated with maternal morbidity and is managed by immediate delivery or inpatient expectant management. OBJECTIVE This study aimed to compare maternal morbidity in women with preeclampsia with severe features in whom the American College of Obstetricians and Gynecologists recommends immediate delivery versus those eligible for expectant management. STUDY DESIGN This was a retrospective cohort study of women with preeclampsia with severe features delivered between 23 to 34 weeks of gestation from 2013 to 2017 at a single tertiary center. Women were categorized into 2 groups: (1) those recommended by the American College of Obstetricians and Gynecologists for immediate delivery, that is, ineligible for expectant management, and (2) those eligible for expectant management. The primary outcome was composite postpartum maternal morbidity, which included maternal intensive care unit admission, stroke, death, and other severe morbidities. The secondary outcomes included select adverse perinatal outcomes. Groups were compared and adjusted odds ratios (95% confidence intervals) calculated. RESULTS Of the 1172 women with preeclampsia identified during the study period, 543 with preeclampsia with severe features were included for analysis: 211 (39%) were ineligible for expectant management and 332 (61%) were eligible for expectant management. Baseline characteristics, including age, body mass index, race and ethnicity, parity, marital status, and gestational age at preeclampsia diagnosis, were similar between the 2 groups. Women ineligible for expectant management had significantly higher composite postpartum maternal morbidity (adjusted odds ratio, 5.02 [95% confidence interval, 1.35-18.69]). In addition, those ineligible for expectant management were more likely to have postpartum intensive care unit admission (adjusted odds ratio, 4.19 [95% confidence interval, 1.09-16.16]) and postpartum hemoglobin level of <7 g/dL (adjusted odds ratio, 5.07 [95% confidence interval, 1.35-19.08]). There was no demonstrable difference in neonatal outcomes between the 2 groups. CONCLUSION Women with preeclampsia with severe features who were ineligible for expectant management per the American College of Obstetricians and Gynecologists guidelines had a 5-fold increased risk of maternal morbidity, confirming the need for escalation of care and delivery without delay.
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Affiliation(s)
- Sara Jaber
- Department of Obstetrics and Gynecology, Beaumont Hospital Royal Oak, Royal Oak, MI (Dr Jaber).
| | - Victoria C Jauk
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Gabriella D Cozzi
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Aalok R Sanjanwala
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA (Dr Sanjanwala)
| | - David A Becker
- Department of Obstetrics and Gynecology, College of Medicine, The University of Oklahoma, Oklahoma City, OK (Dr Becker)
| | - Lorie M Harper
- Department of Women's Health, Dell Medical School, The University of Texas at Austin, Austin, TX (Dr Harper)
| | - Brian M Casey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Rachel G Sinkey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
| | - Akila Subramaniam
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Ms Jauk and Drs Cozzi, Casey, Sinkey, and Subramaniam); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Cozzi, Casey, Sinkey, and Subramaniam)
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Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, von Dadelszen P, Helewa M, Rey E. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:547-571.e1. [PMID: 35577426 DOI: 10.1016/j.jogc.2022.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This guideline was developed by maternity care providers from obstetrics and internal medicine. It reviews the diagnosis, evaluation, and management of the hypertensive disorders of pregnancy (HDPs), the prediction and prevention of preeclampsia, and the postpartum care of women with a previous HDP. TARGET POPULATION Pregnant women. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may reduce the incidence of the HDPs, particularly preeclampsia, and associated adverse outcomes. EVIDENCE A comprehensive literature review was updated to December 2020, following the same methods as for previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines, and references were restricted to English or French. To support recommendations for therapies, we prioritized randomized controlled trials and systematic reviews (if available), and evaluated substantive clinical outcomes for mothers and babies. VALIDATION METHODS The authors agreed on the content and recommendations through consensus and responded to peer review by the SOGC Maternal Fetal Medicine Committee. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a "good practice point." See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).The Board of the SOGC approved the final draft for publication. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, and anesthesiologists) who provide care to women before, during, or after pregnancy. RECOMMENDATIONS
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Hypertensive Disorders of Pregnancy: Common Clinical Conundrums. Obstet Gynecol Surv 2022; 77:234-244. [PMID: 35395093 DOI: 10.1097/ogx.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Hypertensive complications of pregnancy comprise 16% of maternal deaths in developed countries and 7.4% of deaths in the United States. Rates of preeclampsia increased 25% from 1987 to 2004, and rates of severe preeclampsia have increased 6.7-fold between 1980 and 2003. Objective The aim of this study was to review current and available evidence for common clinical questions regarding the management of hypertensive disorders of pregnancy. Evidence Acquisition Original research articles, review articles, and guidelines on hypertension in pregnancy were reviewed. Results Severe gestational hypertension should be managed as preeclampsia with severe features. Serum uric acid levels can be useful in predicting development of superimposed preeclampsia for women with chronic hypertension. When presenting with preeclampsia with severe features before 34 weeks, expectant management should be considered only when both maternal and fetal conditions are stable. In the setting of hypertensive disorders of pregnancy, oral antihypertensive medications should be initiated when systolic blood pressure is greater than 160 mm Hg or when diastolic blood pressure is greater than 110 mm Hg, with the most ideal agents being labetalol or nifedipine. Furthermore, although risk of preeclampsia recurrence in future pregnancy is low, women with a history of preeclampsia should be managed with 81 mg aspirin daily for preeclampsia prevention. Conclusions and Relevance Despite the frequency with which hypertensive disorders of pregnancy are encountered clinically, situations arise frequently with limited evidence to guide providers in their management. An urgent need exists to better understand this disease to optimize outcomes for impacted patients.
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Abstract
OBJECTIVE This study aimed to compare maternal and neonatal outcomes in women with severe preeclampsia before and after implementation of the American College of Obstetricians and Gynecologists (ACOG) taskforce hypertensive guidelines. STUDY DESIGN Single-center retrospective cohort study of women with severe preeclampsia delivering live nonanomalous singletons 23 to 342/7 weeks from 2013 to 2017. In 2015, the ACOG guidelines for expectant management of severe preeclampsia were implemented at our institution. Based on this, patients were categorized as preguideline (January 2013-December 2015) or postguideline adoption (January 2016-December 2017). Primary outcomes included composite maternal morbidity and composite neonatal morbidity; secondary outcomes included composite components, length of stay, birth weight, and delivery gestational age. Groups were compared with Student's t-test, Chi-square, and Wilcoxon's rank-sum tests; adjusted odds ratios (aOR; 95% confidence intervals [CIs]) were calculated. Yearly composite outcomes were compared using the Cochran-Armitage trend test. We estimated a sample size of 250 per group would provide 80% power at α = 0.05 to detect a 50% reduction in neonatal morbidity from a baseline rate of 21.5%. RESULTS From 2013 to 2017, a total of 543 women with severe preeclampsia were identified: 278 (51%) preguideline and 265 (49%) postguideline. Baseline characteristics were overall similar between groups. There were no significant differences in maternal (aOR = 0.96, 95% CI: 0.6-1.41) or neonatal (aOR = 0.88, 95% CI: 0.61-1.28) composite morbidity between groups. Furthermore, there were no differences in composite maternal or neonatal morbidity over time. CONCLUSION Perinatal outcomes were similar before and after implementation of severe preeclampsia management guidelines at our institution. Studies to evaluate if benefits are limited to subsets of this population, such as earlier gestational ages, are needed. KEY POINTS · Expectant management of severe preeclampsia has yet to be fully evaluated outside of trial conditions.. · We did not see a significant improvement in neonatal composite morbidity/mortality.. · We also did not see a worsened composite maternal morbidity/mortality..
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Gestational Hypertension and Preeclampsia: An Overview of National and International Guidelines. Obstet Gynecol Surv 2021; 76:613-633. [PMID: 34724074 DOI: 10.1097/ogx.0000000000000942] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Gestational hypertension and preeclampsia are leading causes of maternal and perinatal morbidity and mortality worldwide. Τhe lack of effective screening and management policies appears to be one of the main reasons. Objective The aim of this study was to review and compare recommendations from published guidelines on these common pregnancy complications. Evidence Acquisition A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Society of Obstetric Medicine of Australia and New Zealand, the International Society of Hypertension, the International Society for the Study of Hypertension in Pregnancy, the European Society of Cardiology, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada, the American College of Obstetricians and Gynecologists, the International Society of Ultrasound in Obstetrics and Gynecology, the World Health Organization, and the US Preventive Services Task Force on gestational hypertension and preeclampsia was carried out. Results There is an overall agreement that, in case of suspected preeclampsia or new-onset hypertension, blood and urine tests should be carried out, including dipstick test for proteinuria, whereas placental growth factor-based testing is only recommended by the National Institute for Health and Care Excellence and the European Society of Cardiology. In addition, there is a consensus on the recommendations for the medical treatment of severe and nonsevere hypertension, the management of preeclampsia, the appropriate timing of delivery, the optimal method of anesthesia and the mode of delivery, the administration of antenatal corticosteroids and the use of magnesium sulfate for the treatment of eclamptic seizures, the prevention of eclampsia in cases of severe preeclampsia, and the neuroprotection of preterm neonates. The reviewed guidelines also state that, based on maternal risk factors, pregnant women identified to be at high risk for preeclampsia should receive low-dose aspirin starting ideally in the first trimester until labor or 36 to 37 weeks of gestation, although the recommended dose varies between 75 and 162 mg/d. Moreover, most guidelines recommend calcium supplementation for the prevention of preeclampsia and discourage the use of other agents. However, controversy exists regarding the definition and the optimal screening method for preeclampsia, the need for treating mild hypertension, the blood pressure treatment targets, and the postnatal blood pressure monitoring. Conclusions The development and implementation of consistent international protocols will allow clinicians to adopt effective universal screening, as well as preventive and management strategies with the intention of improving maternal and neonatal outcomes.
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Tasta O, Parant O, Hamdi SM, Allouche M, Vayssiere C, Guerby P. Evaluation of the Prognostic Value of the sFlt-1/PlGF Ratio in Early-Onset Preeclampsia. Am J Perinatol 2021; 38:e292-e298. [PMID: 32446261 DOI: 10.1055/s-0040-1709696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Increased expression of soluble fms-like tyrosine kinase 1 (sFlt-1), associated with a decrease in placental growth factor (PlGF), plays a key role in the pathogenesis of preeclampsia (PE). We evaluated the prognostic value of the sFlt-1/PlGF ratio for the onset of adverse maternofetal outcomes (AMFO) in case of early-onset PE with attempted expectant management. STUDY DESIGN From October 2016 through November 2018, all singleton pregnancies complicated by early-onset PE (before 34 weeks of gestation) were included in a cohort study. The plasma levels of sFlt-1 and PlGF were blindly measured on admission. For the statistical analysis, we performed a bivariate analysis, a comparison of the receiving operating characteristic curves and a survival analysis estimated by the Kaplan-Meier method. RESULTS Among 109 early PE, AMFO occurred in 87 pregnancies (79.8%), mainly hemolysis, elevated liver enzymes, and low platelet count syndrome and severe fetal heart rate abnormalities requiring urgent delivery. The area under the curve (AUC) of sFlt-1/PlGF ratio was 0.82 (95% confidence interval [CI]: 0.73-0.88) for the risk of AMFO and the difference between the AUCs was significant for each separate standard parameter (p = 0.018 for initial diastolic blood pressure, p = 0.013 for alanine aminotransferase, p < 0.001 for uric acid). Pregnancies were best classified by a cutoff ratio of 293, with a sensitivity of 95% and a specificity of 50%. With a ratio value less than 293, no pregnancy was complicated or had been stopped during the first 5 days. A ratio more than 293 was associated with an increased risk of AMFO onset (hazard ratio [HR]: 3.61; 95% CI: 2.13-6.10; p < 0.001) and had a significant association with the length of time between the diagnosis of PE and delivery (HR: 2.49; 95% CI: 1.56-3.96; p < 0.001). CONCLUSION The sFlt-1/PlGF ratio is an additional tool in the prediction of AMFO in proven early-onset PE, which is likely to improve care by anticipating severe complications. KEY POINTS · The sFlt-1/PlGF ratio is associated with AMFO.. · It is an additional tool for physician.. · We proposed a 293 cutoff value for the ratio..
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Affiliation(s)
- Oriane Tasta
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Olivier Parant
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Safouane M Hamdi
- Department of Biochemistry and Hormonology, Paul Sabatier University, Toulouse, France
| | - Mickael Allouche
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Christophe Vayssiere
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France
| | - Paul Guerby
- Department of Obstetrics and Gynecology, Paule de Viguier Maternity, CHU Toulouse, Toulouse, France.,INSERM UMR 1048 I2MC, Université de Toulouse III, Toulouse, France
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11
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Kole MB, Villavicencio J, Werner EF. Reproductive services for the patient at increased risk for morbidity and mortality during the second trimester. Semin Perinatol 2020; 44:151270. [PMID: 32624201 DOI: 10.1016/j.semperi.2020.151270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Some complications of pregnancy that occur in the second trimester, such as preeclampsia, bleeding placenta previa, and preterm premature rupture of membranes, require delivery to avoid maternal morbidity and mortality. When these situations occur before fetal viability, pregnancy termination, either by induction of labor or dilation and evacuation, can be lifesaving. To optimize maternal health in these situations, Maternal Fetal Medicine providers should be trained to provide all needed medical services, including termination. Currently, only the minority of Maternal Fetal Medicine providers are skilled in dilation and evacuation. Training programs should focus on ways to facilitate training in second trimester dilation and evacuation to improve care access and quality when these medically necessary procedures are needed for women in whom a healthy pregnancy is no longer an option.
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Affiliation(s)
- Martha B Kole
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02906, United States.
| | - Jennifer Villavicencio
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, United States
| | - Erika F Werner
- Division of Maternal Fetal Medicine, Women and Infants Hospital, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02906, United States
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12
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Peterson JA, Sandgren K, Levine LD. Severe preterm preeclampsia: an examination of outcomes by race. Am J Obstet Gynecol MFM 2020; 2:100181. [PMID: 33345907 DOI: 10.1016/j.ajogmf.2020.100181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/29/2020] [Accepted: 07/11/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preeclampsia complicates 5% to 8% of all pregnancies. Previous studies have examined the maternal morbidity and mortality associated with preeclampsia and the expectant management of severe preterm preeclampsia. However, these studies either did not comment on outcomes by race or were primarily made up of nonblack participants. OBJECTIVE This study aimed to determine whether maternal morbidity associated with the expectant management of severe preterm preeclampsia varied by race. STUDY DESIGN We performed a retrospective cohort study of women with a diagnosis of severe preterm preeclampsia at <34 weeks' gestation between 2008 and 2017 at our institution. Severe preterm preeclampsia was defined by current American College of Obstetricians and Gynecologists guidelines. The primary outcome was a maternal morbidity composite, defined as experiencing ≥1 of the following: hemolysis, elevated liver enzymes, and low platelet count; eclampsia; pulmonary edema; severe renal dysfunction; abruption; maternal intensive care unit admission; venous thromboembolism; blood transfusion; hysterectomy; stroke; or death. Secondary outcomes included a composite of neonatal morbidity. Outcomes were compared between self-reported black and nonblack women. RESULTS In this study, 275 women were included; among those women, 91 (33%) were nonblack, and 184 (67%) were black. In addition, 203 of 275 women (approximately 74%) underwent expectant management with no difference by race (75.8% of nonblack vs 72.8% of black women; P=.6). When examining maternal morbidity, 62 of the expectantly managed women (30.5%) developed the composite maternal morbidity outcome, with no difference by race (27.5% of nonblack vs 32.1% of black women; P=.5) even when adjusting for confounders such as maternal age, body mass index, and parity (adjusted odds ratio, 1.02; 95% confidence interval, 0.97-1.35). The median time from diagnosis to delivery (latency time) was 3 days, with no difference between the 2 groups (P=.9) and no difference in neonatal morbidity (60.9% nonblack vs 53% black; P=.3). CONCLUSION Within our population, there were no differences in maternal outcomes between black and nonblack women who were undergoing expectant management of severe preterm preeclampsia. More research is needed to determine if the known disparities in maternal morbidity among races are due to factors beyond the antepartum management of severe preterm preeclampsia.
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Affiliation(s)
- Jessica A Peterson
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Kirsten Sandgren
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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13
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Barton JR, Saade GR, Sibai BM. A Proposed Plan for Prenatal Care to Minimize Risks of COVID-19 to Patients and Providers: Focus on Hypertensive Disorders of Pregnancy. Am J Perinatol 2020; 37:837-844. [PMID: 32396947 PMCID: PMC7356071 DOI: 10.1055/s-0040-1710538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hypertensive disorders are the most common medical complications of pregnancy and a major cause of maternal and perinatal morbidity and death. The detection of elevated blood pressure during pregnancy is one of the cardinal aspects of optimal antenatal care. With the outbreak of novel coronavirus disease 2019 (COVID-19) and the risk for person-to-person spread of the virus, there is a desire to minimize unnecessary visits to health care facilities. Women should be classified as low risk or high risk for hypertensive disorders of pregnancy and adjustments can be accordingly made in the frequency of maternal and fetal surveillance. During this pandemic, all pregnant women should be encouraged to obtain a sphygmomanometer. Patients monitored for hypertension as an outpatient should receive written instructions on the important signs and symptoms of disease progression and provided contact information to report the development of any concern for change in status. As the clinical management of gestational hypertension and preeclampsia is the same, assessment of urinary protein is unnecessary in the management once a diagnosis of a hypertensive disorder of pregnancy is made. Pregnant women with suspected hypertensive disorders of pregnancy and signs and symptoms associated with the severe end of the disease spectrum (e.g., headaches, visual symptoms, epigastric pain, and pulmonary edema) should have an evaluation including complete blood count, serum creatinine level, and liver transaminases (aspartate aminotransferase and alanine aminotransferase). Further, if there is any evidence of disease progression or if acute severe hypertension develops, prompt hospitalization is suggested. Current guidelines from the American College of Obstetricians and Gynecologists (ACOG) and The Society for Maternal-Fetal Medicine (SMFM) for management of preeclampsia with severe features suggest delivery after 34 0/7 weeks of gestation. With the outbreak of COVID-19, however, adjustments to this algorithm should be considered including delivery by 30 0/7 weeks of gestation in the setting of preeclampsia with severe features. KEY POINTS: · Outbreak of novel coronavirus disease 2019 (COVID-19) warrants fewer office visits.. · Women should be classified for hypertension risk in pregnancy.. · Earlier delivery suggested with COVID-19 and hypertensive disorder..
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Affiliation(s)
- John R. Barton
- Division of Maternal–Fetal Medicine, Baptist Health Lexington, Lexington, Kentucky,Address for correspondence John R. Barton, MD, MS Perinatal Diagnostic Center, 1740 Nicholasville Road, Lexington, KY 40503
| | - George R. Saade
- Division of Maternal–Fetal Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Baha M. Sibai
- Department of Obstetrics, Gynecology, Reproductive Sciences, University of Texas-Houston, Houston, Texas
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14
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Liu D, Li C, Huang P, Fu J, Dong X, Tang Y, Li X, Chen Q. Serum levels of uric acid may have a potential role in the management of immediate delivery or prolongation of pregnancy in severe preeclampsia. Hypertens Pregnancy 2020; 39:260-266. [PMID: 32345065 DOI: 10.1080/10641955.2020.1761377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the biomarker(s) that could affect the decision for immediate or delayed delivery in severe preeclampsia. METHODS Data on serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), creatinine, blood urea nitrogen (BUN), uric acid (UA) and platelet counts from 134 cases were collected and analysed. RESULTS Higher UA levels were seen in case with immediate delivery. Higher stillbirth was seen in cases with delayed delivery. CONCLUSION UA levels could be a potential management biomarker for immediate or delayed delivery in severe preeclampsia. However, the higher risk of stillbirth must be considered in delayed delivery.
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Affiliation(s)
- Dan Liu
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University China , Xi'an, China
| | - Chunfang Li
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University China , Xi'an, China
| | - Pu Huang
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University China , Xi'an, China
| | - Jing Fu
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University China , Xi'an, China
| | - Xin Dong
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University China , Xi'an, China
| | - Yunhui Tang
- The Hospital of Obstetrics & Gynaecology, Fudan University China , Shanghai, China
| | - Xuelan Li
- Department of Obstetrics & Gynaecology, First Affiliated Hospital of Xi'an Jiaotong University China , Xi'an, China
| | - Qi Chen
- The Hospital of Obstetrics & Gynaecology, Fudan University China , Shanghai, China.,Department of Obstetrics & Gynaecology, The University of Auckland , Auckland, New Zealand
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15
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Belay Tolu L, Yigezu E, Urgie T, Feyissa GT. Maternal and perinatal outcome of preeclampsia without severe feature among pregnant women managed at a tertiary referral hospital in urban Ethiopia. PLoS One 2020; 15:e0230638. [PMID: 32271787 PMCID: PMC7144970 DOI: 10.1371/journal.pone.0230638] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/04/2020] [Indexed: 11/23/2022] Open
Abstract
Background Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Pregnant women with preeclampsia are at an increased risk of adverse maternal, fetal and neonatal complications. The objective of the study is, therefore, to determine the maternal and perinatal outcome of preeclampsia without severity feature among women managed at a tertiary referral hospital in urban Ethiopia. Methods A hospital-based prospective observational study was conducted to evaluate the maternal and perinatal outcome of pregnant women who were on expectant management with the diagnosis of preeclampsia without severe feature at a referral hospital in urban Ethiopia from August 2018 to January 2019. Results There were a total of 5400 deliveries during the study period, among which 164 (3%) women were diagnosed with preeclampsia without severe features. Fifty-one (31.1%) patients with preeclampsia without severe features presented at a gestational age between 28 to 33 weeks plus six days, while 113 (68.9%) presented at a gestational age between 34 weeks to 36 weeks. Fifty-two (31.7%) women had maternal complication of which, 32 (19.5%) progressed to preeclampsia with severe feature Those patients with early onset of preeclampsia without severe feature were 5.22 and 25.9 times more likely to develop maternal and perinatal complication respectively compared to late-onset after 34 weeks with P-value of <0.0001, (95% CI 2.01–13.6) and <0.0001(95% CI 5.75–115.6) respectively. Conclusion In a setting where home-based self-care is poor expectant outpatient management of preeclampsia without severe features with a once per week visit is not adequate. It’s associated with an increased risk of maternal and perinatal morbidity and mortality. Our findings call for special consideration and close surveillance of those women with early-onset diseases.
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Affiliation(s)
- Lemi Belay Tolu
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Endale Yigezu
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tadesse Urgie
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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16
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Venkatesh KK, Strauss RA, Westreich DJ, Thorp JM, Stamilio DM, Grantz KL. Adverse maternal and neonatal outcomes among women with preeclampsia with severe features <34 weeks gestation with versus without comorbidity. Pregnancy Hypertens 2020; 20:75-82. [PMID: 32193149 DOI: 10.1016/j.preghy.2020.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/08/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine adverse maternal and neonatal outcomes among women with preeclampsia with severe features who delivered <34 weeks comparing those with versus without a comorbid condition. STUDY DESIGN A retrospective analysis from the U.S. Consortium on Safe Labor Study of deliveries <34 weeks with preeclampsia with severe features. We examined the association of each comorbid condition versus none with adverse maternal and neonatal outcomes. The comorbidities (not mutually exclusive) were chronic hypertension, pregestational diabetes, gestational diabetes, twin gestation, and fetal growth restriction. MAIN OUTCOMES Maternal outcome: eclampsia, thromboembolism, ICU admission, and/or death; and neonatal outcome: intracranial/periventricular hemorrhage, hypoxic-ischemic encephalopathy/periventricular leukomalacia, stillbirth, and/or perinatal death. RESULTS Among 2217 deliveries, 50% had a comorbidity, namely chronic hypertension (30%), pregestational diabetes (8%), gestational diabetes (8%), twin gestation (10%), and fetal growth restriction (7%). Adverse maternal and neonatal outcomes occurred in 10% and 12% of pregnancies, respectively. Pregnancies with preeclampsia with severe features delivered <34 weeks complicated by gestational diabetes (adjusted risk difference, aRD: -4.9%, 95%CI: -9.11 to -0.71), twin gestation (aRD: -5.1%, 95%CI: -8.63 to -1.73), and fetal growth restriction (aRD: -4.7%, 95%CI: -7.96 to -1.62) were less likely to result in adverse maternal outcome compared to pregnancies without comorbidity, but not chronic hypertension and pregestational diabetes. A pregnancy complicated by fetal growth restriction (aRD: 12.2%, 95%CI: 5.48 to 19.03) was more likely to result in adverse neonatal outcome, but not other comorbid conditions. CONCLUSIONS Preeclampsia with severe features <34 weeks complicated by comorbidity was generally not associated with an increased risk of adverse maternal and neonatal outcomes, with the exception of fetal growth restriction.
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina (Chapel Hill, NC), United States.
| | - Robert A Strauss
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina (Chapel Hill, NC), United States
| | - Daniel J Westreich
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina (Chapel Hill, NC), United States
| | - John M Thorp
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina (Chapel Hill, NC), United States
| | - David M Stamilio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina (Chapel Hill, NC), United States
| | - Katherine L Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (Bethesda, MD), United States
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17
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Puia-Dumitrescu M, Greenberg RG, Younge N, Bidegain M, Cotten CM, McCaffrey M, Murtha A, Gutierrez S, DeJoseph J, Cochran KM, Ollendorff A. Disparities in the use of antenatal corticosteroids among women with hypertension in North Carolina. J Perinatol 2020; 40:456-462. [PMID: 31767978 PMCID: PMC7455922 DOI: 10.1038/s41372-019-0555-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/29/2019] [Accepted: 11/07/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate antenatal corticosteroids (ANS) use in pregnant women with hypertension. STUDY DESIGN Retrospective analysis of ANS use in the Perinatal Quality Collaborative of North Carolina between 2015 and 2017. RESULTS Twenty-five centers participated, with 9% (1580/17,692) of mothers delivering at <34 weeks; of these, 81% (1286/1580) received a full course of ANS, which was not different between phases (p = 0.32), or between Level III/IV neonatal intensive care units (NICUs; 82%), and I/II NICUs (76%) (p = 0.05). In Level III/IV NICUs, White mothers were more likely to receive ANS (87%) than African Americans (77%) or other race/ethnicity (80%) (including Hispanics) (p = 0.001). ANS use did not differ among mothers with different payers (p = 0.94). CONCLUSION The rates of full ANS courses did not significantly increase from 2015-2017 and disparities persisted. Targeted efforts to improve ANS exposures among hypertensive African American and Hispanic mothers, as well as in community hospital settings are needed.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington, Seattle, WA, USA,Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Rachel G. Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA,Duke Clinical Research Institute, Durham, NC, USA,Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Noelle Younge
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Margarita Bidegain
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - C. Michael Cotten
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Martin McCaffrey
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA,Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Amy Murtha
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Susan Gutierrez
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Jodi DeJoseph
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Keith M. Cochran
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA
| | - Arthur Ollendorff
- Perinatal Quality Collaborative North Carolina, Chapel Hill, NC, USA,Mountain Area Health Education Center (MAHEC) OB/GYN Specialists, Asheville, NC, USA
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18
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Eugene M I, Alphonsus N O, Assumpta U I. Maternal-perinatal outcome in pregnancies complicated by preeclampsia: Looking at early and late onset disorders. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_37_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Enengl S, Mayer RB, Le Renard PE, Shebl O, Arzt W, Oppelt P. Retrospective evaluation of established cut-off values for the sFlt-1/PlGF ratio for predicting imminent delivery in preeclampsia patients. Pregnancy Hypertens 2020; 19:143-149. [DOI: 10.1016/j.preghy.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
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20
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Nwafor J, Ugoji DPC, Onwe B, Obi V, Obi C, Uchenna Onuchukwu V, Ibo C. Pregnancy outcomes among women with early-onset severe preeclampsia managed conservatively. SAHEL MEDICAL JOURNAL 2020. [DOI: 10.4103/smj.smj_28_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Acute kidney injury in patients with HELLP syndrome. Int Urol Nephrol 2019; 51:1199-1206. [PMID: 30989565 DOI: 10.1007/s11255-019-02111-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the risk factors and renal prognosis of acute kidney injury (AKI) in patients with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. METHODS Women with HELLP syndrome over a 15-year period at Peking Union Medical College Hospital, China, were retrospectively studied. RESULTS A total of 108 patients with HELLP syndrome were included. Fifty-two (48.1%) patients were diagnosed with AKI (median serum creatinine, 139.72 µmol/L; range, 89.00-866.00); 11 (21.2%) required hemodialysis. The AKI group had significantly more multiparity (p = 0.034), hemorrhage > 400 mL (p = 0.027), severe systolic hypertension ≥ 160 mmHg (p = 0.005), infection (p < 0.001), and low hemoglobin (p = 0.002) than non-AKI patients. Multivariate logistic regression showed that infection (OR 36.441, 95% CI 3.819-347.732, p = 0.002), severe systolic hypertension (OR 5.295, 95% CI 1.795-15.620, p = 0.003), and low hemoglobin (OR 0.960, 95% CI 0.932-0.988, p = 0.006) were independent risk factors for AKI. Six patients with AKI died (mortality rate: 11.5%); no death occurred among patients without AKI. In addition to infection (OR 16.268, CI 1.334-198.385, p = 0.029) and eclampsia (OR 69.895, CI 2.834-1723.910, p = 0.009), elevated serum creatinine (OR 1.006, CI 1.001-1.011, p = 0.031) was an independent predictor of maternal mortality. Renal function in 43 (82.7%) patients completely recovered. Two (3.8%) patients developed chronic renal dysfunction after 1 to 2 years of follow-up. CONCLUSIONS Elevated creatinine was an independent predictor of maternal mortality in HELLP syndrome. AKI severely affects renal prognosis and mortality in pregnant women. The occurrence of AKI was related to infection, severe hypertension, and renal ischemia.
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22
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Re-evaluation of abruptio placentae and other maternal complications during expectant management of early onset pre-eclampsia. Pregnancy Hypertens 2019; 16:38-41. [PMID: 31056158 DOI: 10.1016/j.preghy.2019.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Expectant management of appropriately selected cases of early pre-eclampsia in a dedicated, tertiary in-patient setting with frequent non-invasive maternal and fetal surveillance, prolongs pregnancy, improves perinatal outcome and mitigates the impact of maternal complications. As the rate of abruptio placentae in a large descriptive study performed nearly 20 years ago was 20%, a study to re-evaluate the rate of abruptio placentae and other maternal complications was performed. STUDY DESIGN A retrospective study that included all women admitted for expectant management with stable early pre-eclampsia (≥24 and <34 weeks' gestation) was performed at Tygerberg Hospital, a secondary and tertiary referral centre in South Africa over a period of 12 months. MAIN OUTCOME MEASURES Abruptio placentae and other maternal complications. RESULTS During the study period, 9137 women were delivered at the study institution. The data of 102 of 106 women admitted for expectant management of early pre-eclampsia were available. Thirty-four (33%) reached the elective delivery threshold of 34 weeks. Seventeen women (17%) experienced ≥1 complication. There were four cases (4%) each with abruptio placentae, HELLP syndrome and renal insufficiency. Three of the cases with abruptio placentae were asymptomatic, only being diagnosed at caesarean section for fetal distress. Nine women developed mild/moderate ascites. There were no admissions to the critical care unit and no deaths. CONCLUSIONS Abruptio placentae occurred in 4% of women managed expectantly with early pre-eclampsia and was most often asymptomatic before delivery.
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Gyamfi-Bannerman C, Pandita A, Miller EC, Boehme AK, Wright JD, Siddiq Z, D'Alton ME, Friedman AM. Preeclampsia outcomes at delivery and race. J Matern Fetal Neonatal Med 2019; 33:3619-3626. [PMID: 30786794 DOI: 10.1080/14767058.2019.1581522] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The objective of this study was to assess how race is associated with adverse maternal outcomes in the setting of preeclampsia.Study design: This retrospective cohort study utilized the National (Nationwide) Inpatient Sample (NIS) from the Agency for Health care Research and Quality for the years 2012-2014. Women aged 15-54 with a diagnosis of preeclampsia were included. Race and ethnicity were categorized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific Islander, Native American, other, and unknown. The overall risk for severe morbidity based on Centers for Disease Control and Prevention criteria was analyzed along with the risk for specific outcomes such as stroke, acute heart failure or pulmonary edema, eclampsia, and acute renal failure. The risk for severe morbidity was stratified by comorbid risk and compared by race. Log-linear regression models were created to assess risk for severe morbidity with risk ratios and associated 95% confidence intervals as measures of effect.Results: A total of 101,741 women with preeclampsia from 2012 to 2014 were included in this analysis. The risk for severe morbidity was significantly higher among non-Hispanic black women (9.8%) than non-Hispanic white, Hispanic, and all other women, respectively (6.1, 7.7, and 7.5%, respectively, p < .01). For non-Hispanic black compared to non-Hispanic white, Hispanic, and all other women, risk was higher for stroke (17.1 versus 6.5, 12.7, and 9.3 per 10,000 deliveries, respectively, p < .01) and pulmonary edema or heart failure (56.2 versus 32.7, 30.2, and 38.4 per 10,000 deliveries, respectively, p < .01). Non-Hispanic black women were also more likely than non-Hispanic white women to experience renal failure (136.4 versus 60.4 per 10,000 deliveries, p < .01). Adjusting for comorbidity, black women remained at higher risk for severe morbidity (p < .01). The risk for death was higher for black compared to non-black women (121.8 per 100,000 deliveries, 95% CI 69.7-212.9 versus 24.1 per 100,000 deliveries, 95% CI 14.6-39.8, respectively, p < .01)Conclusion: Black women were at higher risk for severe morbidity and mortality associated with preeclampsia.
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Affiliation(s)
- Cynthia Gyamfi-Bannerman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ambika Pandita
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Eliza C Miller
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Amelia K Boehme
- Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Zainab Siddiq
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Expectant or outpatient management of preeclampsia before 34 weeks: safe for mother but associated with increased stillbirth risk. J Hum Hypertens 2019; 33:664-670. [PMID: 30745577 DOI: 10.1038/s41371-019-0175-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/28/2018] [Accepted: 01/25/2019] [Indexed: 01/09/2023]
Abstract
Today the only effective "treatment" for preeclampsia is to deliver at the optimal time for both maternal and foetal well-being. Studies reported that severe preeclampsia can benefit from the expectant management including mild preeclampsia between 34 and 37 weeks. However it is unclear whether mild preeclampsia before 34 weeks also benefits from the expectant management. Data on 274 women with mild preeclampsia before 37 weeks of gestation were retrospectively collected and analysed. Blood pressure and proteinuria at time of onset were not clinically associated with delivery time. For women who developed preeclampsia before 34 weeks, the median latency from onset to delivery or from onset to admission to hospital or from admission to hospital to delivery was 27 or 21 or 3 days, respectively. There were four women (2%) who delivered within 48 h after onset, 28 (14%) FGR and 14 (7%) stillbirths. The median birth-weight was 2240 g. For women who developed preeclampsia between 34 and 37 weeks, the median latency from onset to delivery or from onset to admission to hospital or from admission to hospital to delivery was 11 or 7 or 2 days, respectively. There were seven women (10%) who delivered within 48 h after onset and eight (12%) FGR. The median birth-weight was 2880 g. Our study demonstrates that mild preeclampsia before 37 weeks has benefits from expectant or outpatient management with a median prolongation of over 11 days dependent on the time of onset, but it increases the risk for stillbirths before 34 weeks.
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Kasim HH, Masri MA, Noh NA, Mokhtar A, Mokhtar RH. Clinical implications of blood pressure variability (BPV) in pregnancies: a review. Horm Mol Biol Clin Investig 2019; 39:/j/hmbci.ahead-of-print/hmbci-2018-0060/hmbci-2018-0060.xml. [PMID: 30712023 DOI: 10.1515/hmbci-2018-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022]
Abstract
Background Hypertension disorder in pregnancy (HDP) is the second most common contributor to maternal morbidity and mortality worldwide. Blood pressure variability (BPV), with the assistance of ambulatory blood pressure monitoring (ABPM), measures blood pressure readings in pregnant women and has the potential to predict the occurrence of pregnancy-induced hypertension (PIH) or preeclampsia (PE) before any symptoms develop. Methodology Studies involving ABPM among pregnant women were identified using electronic databases such as PubMed, Scopus, Google Scholar, ScienceDirect, Medscape, Ovid and ProQuest. These electronic databases were assessed from 1990 to 2018. Keywords used to search for literatures included a combination of BPV matched with pregnancy, pregnant women and HDP, gestational hypertension and/or PE. Results Out of 21,526 articles identified, a total of 10 studies met the criteria. Seven articles used the spectral analysis method while another two articles used a combination of spectral analysis, time domain and a non-linear method for BPV analysis. The final article described BPV as vagal baroreflex. Four articles agreed that high frequency (HF) BPV was mainly dominant from the second trimester until 4 days postpartum in HDP patients. This reflects the dominant features of parasympathetic activities among these patients. Two articles that used time domain also agreed that standard deviation (SD) BPV increased in PE patients. Conclusions In pregnancy, BPV has a strong impact on the knowledge understanding of the disease in clinical fields, allows a superior ability to predict PIH and PE in mid-pregnancy and offers potential value for addressing hypertension in pregnancy.
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Affiliation(s)
- Hanis Hidayu Kasim
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia, Phone: +603-4289 2400, Fax : +603-4289 2477
| | - Maizatul Azma Masri
- Obstetrics and Gynaecology, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Nor Azila Noh
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Azlina Mokhtar
- Surgical Based Discipline, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Rafidah Hanim Mokhtar
- Medical Sciences (Physiology), Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia, Phone: +603-4289 2400, Fax : +603-4289 2477
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Early preterm preeclampsia outcomes by intended mode of delivery. Am J Obstet Gynecol 2019; 220:100.e1-100.e9. [PMID: 30273585 DOI: 10.1016/j.ajog.2018.09.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/09/2018] [Accepted: 09/20/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The optimal route of delivery in early-onset preeclampsia before 34 weeks is debated because many clinicians are reluctant to proceed with induction for perceived high risk of failure. OBJECTIVE Our objective was to investigate labor induction success rates and compare maternal and neonatal outcomes by intended mode of delivery in women with early preterm preeclampsia. STUDY DESIGN We identified 914 singleton pregnancies with preeclampsia in the Consortium on Safe Labor study for analysis who delivered between 24 0/7 and 33 6/7 weeks. We excluded fetal anomalies, antepartum stillbirth, or spontaneous preterm labor. Maternal and neonatal outcomes were compared between women undergoing induction of labor (n = 460) and planned cesarean delivery (n = 454) and women with successful induction of labor (n = 214) and unsuccessful induction of labor (n = 246). We calculated relative risks and 95% confidence intervals to determine outcomes by Poisson regression model with propensity score adjustment. The calculation of propensity scores considered covariates such as maternal age, gestational age, parity, body mass index, tobacco use, diabetes mellitus, chronic hypertension, hospital type and site, birthweight, history of cesarean delivery, malpresentation/breech, simplified Bishop score, insurance, marital status, and steroid use. RESULTS Among the 460 women with induction (50%), 47% of deliveries were vaginal. By gestational age, 24 to 27 6/7, 28 to 31 6/7, and 32 to 33 6/7, the induction of labor success rates were 38% (12 of 32), 39% (70 of 180), and 54% (132 of 248), respectively. Induction of labor compared with planned cesarean delivery was less likely to be associated with placental abruption (adjusted relative risk, 0.33; 95% confidence interval, 0.16-0.67), wound infection or separation (adjusted relative risk, 0.23; 95% confidence interval, 0.06-0.85), and neonatal asphyxia (0.12; 95% confidence interval, 0.02-0.78). Women with vaginal delivery compared with those with failed induction of labor had decreased maternal morbidity (adjusted relative risk, 0.27; 95% confidence interval, 0.09-0.82) and no difference in neonatal outcomes. CONCLUSION About half of women with preterm preeclampsia who attempted an induction had a successful vaginal delivery. The rate of successful vaginal delivery increases with gestational age. Successful induction has the benefit of preventing maternal and fetal comorbidities associated with previous cesarean deliveries in subsequent pregnancies. While overall rates of a composite of serious maternal and neonatal morbidity/mortality did not differ between induction of labor and planned cesarean delivery groups, women with failed induction of labor had increased maternal morbidity highlighting the complex route of delivery counseling required in this high-risk population of women.
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Mode of Delivery in Severe Preeclampsia Before 28 Weeks' Gestation: A Systematic Review. Obstet Gynecol Surv 2018; 73:469-474. [PMID: 30169885 DOI: 10.1097/ogx.0000000000000589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Preeclampsia with an onset before 28 weeks' gestation poses dilemmas for the obstetrician with regard to the mode of delivery. Objective The aim of this study was to analyze the success rate of attempted vaginal delivery and the maternal and neonatal outcome according to the mode of delivery in women with preeclampsia and an indicated delivery before 28 weeks' gestation. Evidence Acquisition A comprehensive search was performed in the bibliographic databases PubMed, Embase.com, and Wiley Cochrane Library. The main outcome was success rate of attempted vaginal delivery. Secondary outcomes were maternal and neonatal outcomes. Results Eight studies describing a total of 800 women were included. Success rates of vaginal delivery varied from 1.8% to 80%, and rates for cesarean delivery after induction of labor varied from 13% to 51%. The rates for planned cesarean delivery varied from 0% to 73%. Two studies (n = 53) described no statistical significant differences in maternal outcomes. Two other studies (n = 107) report no statistical difference in neonatal outcome. Conclusions Studies that report the success rate of attempted vaginal delivery are limited in size. However, giving the available evidence in the reported studies a trial of labor is a considerable option in counseling women with a pregnancy complicated by preeclampsia before 28 weeks' gestation due to the similar maternal and neonatal outcome. No differences in maternal or neonatal outcome were attributed to the mode of delivery, however, numbers are small.
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Weitzner O, Yagur Y, Weissbach T, Man El G, Biron-Shental T. Preeclampsia: risk factors and neonatal outcomes associated with early- versus late-onset diseases. J Matern Fetal Neonatal Med 2018; 33:780-784. [PMID: 30001660 DOI: 10.1080/14767058.2018.1500551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: This study examined the effects of early-onset preeclampsia (EOPE) and late-onset preeclampsia (LOPE) on short-term maternal and neonatal morbidity, as well as risk factors associated with early-onset and late-onset diseases.Method: This retrospective, cohort study included pregnant women who had been diagnosed with PE during pregnancy. Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery data. The women were grouped according to EOPE (<34 weeks) and LOPE (≥34 weeks). Power analysis revealed that a sample size of 35 was sufficient for each PE group, under the assumptions of type I error (two-sided) of 5% and at least 80% power to detect a 30% difference in composite outcomes between EOPE and LOPE.Results: Among 101 patients, 35 (34.7%) had EOPE and 66 (65.3%) developed LOPE. Alpha fetoprotein (AFP) and unconjugated estriol (UE3) were higher in the early-onset group (p = .015 and p= .002, respectively) and might be predictors of EOPE. There was a positive correlation between gestational age at PE diagnosis and gestational age at delivery. Patients with EOPE delivered earlier than patients with LOPE did (p<.0001).Conclusions: Patients who developed EOPE had higher of AFP and UE3 values at their second trimester biochemical screening. These parameters might be predictors of EOPE. We found a positive correlation between early gestational age at PE diagnosis and preterm delivery.
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Affiliation(s)
- Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Weissbach
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Man El
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Li X, Zhang W, Lin J, Liu H, Yang Z, Teng Y, Duan S, Li Y, Xie Y, Lin X, Xie L, Peng Q, Huang J, Chen J, Duan W, Luo J, Zhang J. Preterm birth, low birthweight, and small for gestational age among women with preeclampsia: Does maternal age matter? Pregnancy Hypertens 2018; 13:260-266. [PMID: 30177063 DOI: 10.1016/j.preghy.2018.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To better understand the effects of maternal age on birth outcomes among preeclampsia (PE) patients, we examined the rates of preterm birth, low birthweight, and small for gestational age (SGA) among different age groups and explored whether maternal age was associated with those adverse outcomes. STUDY DESIGN This is a multicenter retrospective study. Data from 1128 PE patients, including 580 with early onset PE and 548 with late onset PE, were analyzed. MAIN OUTCOME MEASURES Maternal age was categorized into three groups: <25, 25-34, and ≥35 years. The outcome variables were preterm birth (<37 weeks; subgroups: <28 weeks, 28-33 weeks, and 34-36 weeks), low birthweight (<2500 g; subgroups: <1500 g and <1000 g), and SGA. Logistic regression was used to analyze the associations between maternal age groups and outcomes. RESULTS In early onset PE, compared with maternal age 25-34 years, maternal age ≥35 years was associated with elevated risk for preterm delivery before 28 weeks, and maternal age <25 years was associated with elevated risk for low birthweight and SGA. When the analysis was restricted to women who underwent cesarean section, elevated risks for preterm birth and/or low birthweight were observed for women younger than 25 years in both early and late onset PE. CONCLUSIONS Among women with PE, maternal age <25 years could add risk to preterm birth and/or low birthweight. For women with early onset PE, maternal age ≥35 years is a risk factor for preterm delivery before 28 weeks.
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Affiliation(s)
- Xun Li
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Weishe Zhang
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China.
| | - Jianhua Lin
- Department of Obstetrics and Gynecology, Renji Hospital of Shanghai Jiaotong University School of Medicine, 145 Shandong Zhonglu, Shanghai 20001, China.
| | - Huai Liu
- Department of Obstetrics, Jiangxi Maternal and Child Health Hospital, 318 Bayi Dadao, Nanchang 330006, China
| | - Zujing Yang
- Department of Obstetrics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yincheng Teng
- Department of Obstetrics and Gynecology, Shanghai Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Si Duan
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yuanqiu Li
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Yingming Xie
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Xinxiu Lin
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Liangqun Xie
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Qiaozhen Peng
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Jingrui Huang
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Jingfei Chen
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Weifang Duan
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Jiefeng Luo
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
| | - Jiejie Zhang
- Department of Obstetrics, Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China
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Role of endogenous digitalis-like factors in the clinical manifestations of severe preeclampsia: a sytematic review. Clin Sci (Lond) 2018; 132:1215-1242. [PMID: 29930141 DOI: 10.1042/cs20171499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Endogenous digitalis-like factor(s), originally proposed as a vasoconstrictor natriuretic hormone, was discovered in fetal and neonatal blood accidentally because it cross-reacts with antidigoxin antibodies (ADAs). Early studies using immunoassays with ADA identified the digoxin-like immuno-reactive factor(s) (EDLF) in maternal blood as well, and suggested it originated in the feto-placental unit. Mammalian digoxin-like factors have recently been identified as at least two classes of steroid compounds, plant derived ouabain (O), and several toad derived bufodienolides, most prominent being marinobufagenin (MBG). A synthetic pathway for MBG has been identified in mammalian placental tissue. Elevated maternal and fetal EDLF, O and MBG have been demonstrated in preeclampsia (PE), and inhibition of red cell membrane sodium, potassium ATPase (Na, K ATPase (NKA)) by EDLF is reversed by ADA fragments (ADA-FAB). Accordingly, maternal administration of a commercial ADA-antibody fragment (FAB) was tested in several anecdotal cases of PE, and two, small randomized, prospective, double-blind clinical trials. In the first randomized trial, ADA-FAB was administered post-partum, in the second antepartum. In the post-partum trial, ADA-FAB reduced use of antihypertensive drugs. In the second trial, there was no effect of ADA-FAB on blood pressure, but the fall in maternal creatinine clearance (CrCl) was prevented. In a secondary analysis using the pre-treatment maternal level of circulating Na, K ATPase (NKA) inhibitory activity (NKAI), ADA-FAB reduced the incidence of pulmonary edema and, unexpectedly, that of severe neonatal intraventricular hemorrhage (IVH). The fall in CrCl in patients given placebo was proportional to the circulating level of NKAI. The implications of these findings on the pathophysiology of the clinical manifestations PE are discussed, and a new model of the respective roles of placenta derived anti-angiogenic (AAG) factors (AAGFs) and EDLF is proposed.
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Stolz M, Zeisler H, Heinzl F, Binder J, Farr A. An sFlt-1:PlGF ratio of 655 is not a reliable cut-off value for predicting perinatal outcomes in women with preeclampsia. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rabinovich A, Holtzman K, Shoham-Vardi I, Mazor M, Erez O. Oligohydramnios is an independent risk factor for perinatal morbidity among women with pre-eclampsia who delivered preterm. J Matern Fetal Neonatal Med 2017; 32:1776-1782. [DOI: 10.1080/14767058.2017.1417377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alex Rabinovich
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Keren Holtzman
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Ilana Shoham-Vardi
- Department of Epidemiology, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Moshe Mazor
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Offer Erez
- Department of Obstetrics & Gynecology, Obstetrical Day Care Center, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Be’er Sheva, Israel
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Ryan D, Cruciata G, Di Paolo PL, Monti S, Mannelli L. Peripartum Patient With Epigastric Pain. Ann Emerg Med 2017; 70:301-337. [PMID: 28844257 PMCID: PMC5576504 DOI: 10.1016/j.annemergmed.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Davinia Ryan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Giuseppe Cruciata
- Department of Radiology, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, USA
| | | | | | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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van Eerden L, de Groot CJM, Zeeman GG, Page-Christiaens GCM, Pajkrt E, Duvekot JJ, Vandenbussche FP, Oei SG, Scheepers HCJ, van Eyck J, Middeldorp JM, Bolte AC. Subsequent pregnancy outcome after mid-trimester termination of pregnancy for preeclampsia. Aust N Z J Obstet Gynaecol 2017; 58:204-209. [PMID: 28850666 DOI: 10.1111/ajo.12691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we determined the outcome of subsequent pregnancies after termination of pregnancy for preeclampsia, with the purpose of presenting data useful for counselling these women on future pregnancies. STUDY DESIGN The cohort consisted of 131 women with a history of termination of pregnancy for preeclampsia. RESULTS Data of 79 pregnancies were available for analysis, including 13 women with chronic hypertension and 16 women with thrombophilia. There were seven miscarriages (8.8%) and 72 ongoing pregnancies. Low-dose aspirin was prescribed for 64 women (89%). The mean gestational age at delivery was 356/7 ± 4 weeks with a mean birth weight of 2571 ± 938 g. Overall recurrence rate for preeclampsia was 29% at a mean gestational age of 32 weeks. Thirty-eight women had an uncomplicated pregnancy (53%). The women with chronic hypertension had the highest recurrence rate of 38%. Neonatal mortality was 4%. CONCLUSION The course of subsequent pregnancies after mid-trimester termination for preeclampsia is uncomplicated in 53% with a recurrence rate for preeclampsia of 29%. The mean gestational age at delivery was 11 weeks later and birth weight 2000 g higher than in the index pregnancy.
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Affiliation(s)
- Leonoor van Eerden
- Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands
| | | | - Gerda G Zeeman
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - Johannes J Duvekot
- Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank P Vandenbussche
- Department of Obstetrics and Gynecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Swan G Oei
- Department of Obstetrics and Gynecology, Maxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, Maastricht Medical Center, Maastricht, The Netherlands
| | - Jim van Eyck
- Department of Obstetrics and Gynecology, Isala Zwolle, Zwolle, The Netherlands
| | - Johanna M Middeldorp
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Antoinette C Bolte
- Department of Obstetrics and Gynecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
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Halliday E, Tan N. Sensorineural hearing loss and acute vestibulopathy in HELLP syndrome: A case report. OTOLARYNGOLOGY CASE REPORTS 2017. [DOI: 10.1016/j.xocr.2017.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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van Esch JJA, van Heijst AF, de Haan AFJ, van der Heijden OWH. Early-onset preeclampsia is associated with perinatal mortality and severe neonatal morbidity. J Matern Fetal Neonatal Med 2017; 30:2789-2794. [PMID: 28282780 DOI: 10.1080/14767058.2016.1263295] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate neonatal outcomes of pregnancies complicated by early-onset preeclampsia (PE) and compare these outcomes to those of gestational age matched neonates born to mothers whose pregnancy was not complicated by early-onset PE. METHODS We analyzed the outcome in 97 neonates born to mothers with early-onset PE (24-32 weeks amenorrhea at diagnosis) and compared it to that of 680 gestational age-matched neonates born between 25-36 weeks due to other etiologies and admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary referral hospital in the Netherlands. We used Chi-square test, Wilcoxon test, and logistic regression analyses. RESULTS Neonates born to PE mothers had a higher perinatal mortality (13% vs. 7%, p = 0.03) and infant mortality (16% vs. 9%, p= 0.03), a 20% lower birth weight (1150 vs. 1430 g, p<0.001), were more often SGA (22% vs. 9%, p < 0.001) and had more neonatal complications as compared to neonates born to mothers without PE. CONCLUSIONS Overall adverse perinatal outcome is significantly worse in neonates born to mothers with early-onset PE. The effect of early-onset PE on perinatal mortality seems partially due to SGA. Whether these differences are due to uteroplacental factors or intrinsic neonatal factors remains to be elucidated.
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Affiliation(s)
- Joris J A van Esch
- a Department of Obstetrics and Gynecology , Radboud University Medical Centre, Nijmegen , the Netherlands
| | - Arno F van Heijst
- b Department of Neonatology , Radboud University Medical Centre, Nijmegen , the Netherlands
| | - Anton F J de Haan
- c Department for Health Evidence , Radboud University Medical Centre, Nijmegen , the Netherlands
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van Oostwaard MF, van Eerden L, de Laat MW, Duvekot JJ, Erwich JJHM, Bloemenkamp KWM, Bolte AC, Bosma JPF, Koenen SV, Kornelisse RF, Rethans B, van Runnard Heimel P, Scheepers HCJ, Ganzevoort W, Mol BWJ, de Groot CJ, Gaugler-Senden IPM. Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation, a case series. BJOG 2017; 124:1440-1447. [DOI: 10.1111/1471-0528.14512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/28/2022]
Affiliation(s)
- MF van Oostwaard
- Department of Obstetrics and Gynaecology; IJsselland Ziekenhuis; Capelle aan den Ijssel the Netherlands
| | - L van Eerden
- Department of Obstetrics and Gynaecology; Maasstad Ziekenhuis; Rotterdam the Netherlands
| | - MW de Laat
- Department of Obstetrics and Gynaecology; Academisch Medisch Centrum; Amsterdam the Netherlands
| | - JJ Duvekot
- Department of Obstetrics and Gynaecology; Erasmus Medisch Centrum; Rotterdam the Netherlands
| | - JJHM Erwich
- Department of Obstetrics and Gynaecology; Universitair Medisch Centrum Groningen; Groningen the Netherlands
| | - KWM Bloemenkamp
- Department of Obstetrics and Gynaecology; Leids Universitair Medisch Centrum; Leiden the Netherlands
| | - AC Bolte
- Department of Obstetrics and Gynaecology; Radboud Universitair Medisch Centrum; Nijmegen the Netherlands
| | - JPF Bosma
- Department of Obstetrics and Gynaecology; Isala Ziekenhuis; Zwolle the Netherlands
| | - SV Koenen
- Department of Obstetrics and Gynaecology; Universitair Medisch Centrum Utrecht; Utrecht the Netherlands
| | - RF Kornelisse
- Department of Paediatrics; Erasmus Medisch Centrum; Rotterdam the Netherlands
| | - B Rethans
- Department of Obstetrics and Gynaecology; Academisch Medisch Centrum; Amsterdam the Netherlands
| | - P van Runnard Heimel
- Department of Obstetrics and Gynaecology; Maxima Medisch Centrum; Veldhoven the Netherlands
| | - HCJ Scheepers
- Department of Obstetrics and Gynaecology; Maastricht Universitair Medisch Centrum; Maastricht the Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynaecology; Academisch Medisch Centrum; Amsterdam the Netherlands
| | - BWJ Mol
- School of Paediatrics and Reproductive Health; University of Adelaide; Adelaide SA Australia
| | - CJ de Groot
- Department of Obstetrics and Gynaecology; VU Universitair Medisch Centrum; Amsterdam the Netherlands
| | - IPM Gaugler-Senden
- Department of Obstetrics and Gynaecology; Jeroen Bosch Ziekenhuis; ‘s-Hertogenbosch the Netherlands
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Recurrent HELLP Syndrome at 22 Weeks of Gestation. Case Rep Obstet Gynecol 2017; 2017:9845637. [PMID: 28929001 PMCID: PMC5591908 DOI: 10.1155/2017/9845637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/12/2017] [Accepted: 07/09/2017] [Indexed: 12/03/2022] Open
Abstract
We describe a case of a woman who presented with HELLP syndrome in two subsequent pregnancies (age 36 and 40), at gestational age of 22 weeks in both pregnancies with a rapid onset and progression. She presented with characteristic clinical symptoms and laboratory findings. Both pregnancies were delivered by caesarean sections due to deterioration in the mother's condition, although neither pregnancy progressed into the 1st stage of the syndrome according to Mississippi classification. This case highlights the admittedly rare but serious condition of recurring HELLP syndrome at a gestational age before the limit of viability of the fetus. In such situations, pregnancy termination should be considered to minimise risk to the mother's life and health.
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Long W, Rui C, Song X, Dai X, Xue X, Lu Y, Shen R, Li J, Li J, Ding H. Distinct expression profiles of lncRNAs between early-onset preeclampsia and preterm controls. Clin Chim Acta 2016; 463:193-199. [PMID: 27816668 DOI: 10.1016/j.cca.2016.10.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022]
Abstract
Early-onset preeclampsia (EOPE), which is the most severe form of the syndrome, confers a high risk of neonatal morbidity and perinatal death. We aim to study the roles of long non-coding RNAs (lncRNAs) in the pathogenesis of early-onset preeclampsia (EOPE). Therefore, we examined the expression profiles of lncRNAs between early-onset preeclampsia and preterm controls using microarray analysis. Quantitative real-time PCR (qRT-PCR) was performed to verify the selected differentially expressed lncRNAs. In total, we identified 15,646 upregulated and 13,178 downregulated lncRNAs in the placenta of EOPE patients compared to the preterm controls. Gene ontology and pathway analysis revealed that compared to the preterm controls, many of the processes over-represented in the EOPE patients were related to cell migration and cell motility. A selection of the differentially expressed lncRNA transcripts was confirmed using qRT-PCR, particularly RP11-465L10.10, which is associated with the MMP9 gene. These data may offer a background/reference resource for future functional studies of lncRNAs related to EOPE.
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Affiliation(s)
- Wei Long
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Can Rui
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Xuejing Song
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Xiaonan Dai
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Xuan Xue
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Yuanqing Lu
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Rong Shen
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Jun Li
- Maternal and Child Health Medical Institute, Department of Plastic & Cosmetic Surgery, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China
| | - Jingyun Li
- Maternal and Child Health Medical Institute, Department of Plastic & Cosmetic Surgery, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China.
| | - Hongjuan Ding
- Department of Obstetrics, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, China.
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Van Eerden L, Van Oostwaard MF, Zeeman GG, Page-Christiaens GC, Pajkrt E, Duvekot JJ, Vandenbussche FP, Oei SG, Scheepers HC, Van Eyck J, Middeldorp JM, Koenen SV, De Groot CJ, Bolte AC. Terminating pregnancy for severe hypertension when the fetus is considered non-viable: a retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2016; 206:22-26. [DOI: 10.1016/j.ejogrb.2016.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 06/23/2016] [Accepted: 08/01/2016] [Indexed: 11/25/2022]
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Ananth CV, Lavery JA, Friedman AM, Wapner RJ, Wright JD. Serious maternal complications in relation to severe pre-eclampsia: a retrospective cohort study of the impact of hospital volume. BJOG 2016; 124:1246-1253. [PMID: 27770512 DOI: 10.1111/1471-0528.14384] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined rates of serious maternal complications in relation to severe pre-eclampsia based on the delivering hospital's annualised volume. DESIGN Retrospective cohort study. POPULATION AND SETTING Singleton deliveries (n = 25 782 235) in 439 hospitals in the USA. METHODS Annualised hospital volume was categorised as 25-500, 501-1000, 1001-2000 and >2000. MAIN OUTCOME MEASURES Rates of in-hospital maternal death and serious maternal complications, including puerperal cerebrovascular disorders, pulmonary oedema, disseminated intravascular coagulation, acute renal, heart and liver failure, sepsis, haemorrhage and intubation in relation to severe pre-eclampsia. We derived adjusted risk ratio (RR) and 95% confidence interval (CI), from hierarchical Poisson regression models. RESULTS Severe pre-eclampsia was associated with an 8.7-fold (95% CI 7.6, 10.1) risk of composite maternal complications, with similar RRs across levels of hospital volumes. However, compared with hospitals with low annual volume (<2000), maternal mortality rates in relation to severe pre-eclampsia were lower in high volume hospitals. The rates of serious maternal complications were 410.7 per 10 000 to women who delivered in hospitals with a high rate of severe pre-eclampsia (≥2.12%) and 584.8 per 10 000 to women who delivered in hospitals with low severe pre-eclampsia rates (≤0.41; RR 1.75, 95% CI 1.24, 2.45). CONCLUSIONS While the risks of serious maternal complications in relation to severe pre-eclampsia was similar across hospital delivery volume categories, deaths showed lower rates in large delivery volume hospitals than in smaller volume hospitals. The risk of complications was increased in hospitals with low compared with high severe pre-eclampsia rates. TWEETABLE ABSTRACT Hospital volume had little impact on the association between severe pre-eclampsia and maternal complications.
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Affiliation(s)
- C V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J A Lavery
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - A M Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - R J Wapner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - J D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Levine LD, Elovitz MA, Limaye M, Sammel MD, Srinivas SK. Induction, labor length and mode of delivery: the impact on preeclampsia-related adverse maternal outcomes. J Perinatol 2016; 36:713-7. [PMID: 27195978 PMCID: PMC5483181 DOI: 10.1038/jp.2016.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/16/2016] [Accepted: 03/11/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objectives were to evaluate whether induction, specifically prolonged labor, was associated with adverse maternal outcomes related to preeclampsia with severe features (PEC-S) and whether cesarean affected the rate. STUDY DESIGN This was a retrospective cohort study of women with PEC-S ⩾34 weeks who were diagnosed either before planned cesarean or before induction/latent labor. The primary outcome was a composite adverse maternal outcome related to PEC-S. RESULTS The final cohort comprised 193 women (n=172 with labor and n=21 with planned cesarean). The prevalence of the outcome was 15.5%. Women exposed to labor did not have a higher rate compared with planned cesarean (16.3% vs 9.5%, P=0.4). Adjusting for confounders, women with a cesarean after prolonged labor had a 10-fold higher adverse outcome risk compared with women with a planned cesarean (adjusted odds ratio (aOR) 9.7 (1.2 to 78.6), P=0.03) or with a vaginal delivery <24 h (aOR 9.7 (1.4 to 67.4), P=0.02). CONCLUSION Prolonged labor and cesarean in labor were both associated with an increase in our outcome.
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Affiliation(s)
- LD Levine
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - MA Elovitz
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M Limaye
- Department of Obstetrics & Gynecology, Women and Infants Hospital, Alpert Medical School at Brown University, Providence, RI, USA
| | - MD Sammel
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, and Women’s Health Clinical Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - SK Srinivas
- Maternal and Child Health Research Program, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Ueda A, Kondoh E, Kawasaki K, Mogami H, Chigusa Y, Konishi I. Magnesium sulphate can prolong pregnancy in patients with severe early-onset preeclampsia. J Matern Fetal Neonatal Med 2016; 29:3115-20. [PMID: 26513699 DOI: 10.3109/14767058.2015.1114091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess whether long-term use of magnesium sulphate prolongs pregnancy in patients with severe early-onset preeclampsia. METHODS Retrospective cohort study included all singleton pregnancies with severe early-onset preeclampsia, expectantly managed in our institution between 2005 and 2013. Obstetric and perinatal outcomes were compared between patients managed using a current protocol that tolerates long-term (over 48 h) use of magnesium sulphate (long-term group, n = 26) and a historical control group (control group, n = 15) that underwent conventional treatment (up to 48 h use of magnesium sulphate). RESULTS Long-term group showed significant prolongation of pregnancy compared with the control group (9.2 ± 7.9 versus 16.6 ± 9.3 d, log-rank test, p = 0.021), which was also observed in patients with severe preeclampsia occurring before 28 weeks' gestation (n = 11, 4.5 ± 5.2 versus 13.2 ± 6.8 d, log-rank test, p = 0.035). In contrast to a progressive decrease of platelet count in patients managed without magnesium sulphate, administration of magnesium sulphate for 7 d prevented the decrease of platelet count (p = 0.001). Thirty two percent of patients (13/41) experienced a major complication irrespective of duration of magnesium sulphate use. CONCLUSIONS Long-term use of magnesium sulphate prolonged pregnancy in patients with severe early-onset preeclampsia and can help alleviate progression of preeclampsia.
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Affiliation(s)
- Akihiko Ueda
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Eiji Kondoh
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Kaoru Kawasaki
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Haruta Mogami
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Yoshitsugu Chigusa
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
| | - Ikuo Konishi
- a Department of Gynecology and Obstetrics , Kyoto University , Kyoto , Japan
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McLaughlin K, Drewlo S, Parker JD, Kingdom JC. Current Theories on the Prevention of Severe Preeclampsia With Low-Molecular Weight Heparin. Hypertension 2015; 66:1098-103. [DOI: 10.1161/hypertensionaha.115.05770] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/02/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Kelsey McLaughlin
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
| | - Sascha Drewlo
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
| | - John D. Parker
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
| | - John C.P. Kingdom
- From the Division of Cardiology, Department of Medicine, Mount Sinai Hospital (K.M., J.D.P.), Department of Pharmacology and Toxicology (K.M., J.D.P.), and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology (J.C.P.K.), University of Toronto, Toronto, Canada; The Centre for Women’s and Infant’s Health at the Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada (K.M., J.C.P.K.); and Department of Obstetrics and Gynecology, Wayne State University
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Valent AM, DeFranco EA, Sibai BM. Reply: To PMID 25448508. Am J Obstet Gynecol 2015; 213:750-1. [PMID: 26188113 DOI: 10.1016/j.ajog.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/25/2022]
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Audibert F, Bujold E, Côté AM, Douglas MJ, Eastabrook G, Firoz T, Gibson P, Gruslin A, Hutcheon J, Koren G, Lange I, Leduc L, Logan AG, MacDonell KL, Moutquin JM, Sebbag I. The hypertensive disorders of pregnancy (29.3). Best Pract Res Clin Obstet Gynaecol 2015; 29:643-57. [DOI: 10.1016/j.bpobgyn.2015.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features. ACTA ACUST UNITED AC 2015; 40:2839-49. [DOI: 10.1007/s00261-015-0481-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yuce T, Keskin M, Seval MM, Söylemez F. Effect of the timing of delivery on perinatal outcomes at gestational hypertension. Interv Med Appl Sci 2015; 7:59-62. [PMID: 26120477 DOI: 10.1556/1646.7.2015.2.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/02/2015] [Accepted: 04/06/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the perinatal outcomes of women diagnosed with gestational hypertension and no proteinuria according to the gestational weeks. METHODS We included women diagnosed with gestational hypertension between 2010 and 2014 at our institution and excluded the patients with preeclampsia and chronic hypertension. Women with gestational hypertension were grouped according to the gestational weeks. One group consisted of the pregnancies between 37 and 38*6, whereas the other group included pregnancies between 39 and 41 weeks. Then the outcomes of these pregnancies were compared with healthy women who had delivery between the same weeks (37-38*6 weeks and 39-41 weeks). We analyzed the mode of delivery, birth weight, and neonatal outcomes of these pregnancies. RESULTS First and fifth minute Apgar scores were significantly decreased in women with gestational hypertension who had delivery between 39 and 41 weeks compared to healthy subjects (respectively, p = 0.005 and p = 0.033). Perinatal outcomes were adversely affected if the time of delivery was beyond 39 weeks in pregnancies complicated with gestational hypertension. CONCLUSION We concluded that perinatal outcomes were adversely affected if the time of delivery was beyond 39 weeks in pregnancies complicated with gestational hypertension, and outcomes of such pregnancies can be improved if time for delivery is <39 weeks.
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Valdés E, Sepúlveda-Martínez Á, Tong A, Castro M, Castro D. Assessment of Protein:Creatinine Ratio versus 24-Hour Urine Protein in the Diagnosis of Preeclampsia. Gynecol Obstet Invest 2015; 81:78-83. [DOI: 10.1159/000381773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/18/2015] [Indexed: 11/19/2022]
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Abstract
OBJECTIVE To examine temporal trends in early-onset compared with late-onset preeclampsia and associated severe maternal morbidity. METHODS The study included all singleton deliveries in Washington State between 2000 and 2008 (N=670,120). Preeclampsia onset was determined using hospital records linked to birth certificates. Severe maternal morbidity was defined as any potentially life-threatening condition. Logistic regression was used to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). RESULTS The preeclampsia rate was 3.0 per 100 singleton births, and increased slightly from 2.9 to 3.1 between 2000 and 2008. Rates of early-onset and late-onset disease were 0.3% and 2.7%, respectively. The temporal increase was significant only for early-onset disease (4.5%/year; 95% CI 2.3-5.8%) after adjustment for changes in maternal characteristics. Maternal death rates were higher among women with early-onset (42.1/100,000 deliveries) and late-onset preeclampsia (11.2/100,000) compared with women without preeclampsia (4.2/100,000). The rate of severe maternal morbidity (excluding obstetric trauma) was 12.2 per 100 deliveries in the early-onset group (aOR 3.7, 95% CI 3.2-4.3), 5.5 per 100 deliveries in the late-onset group (aOR 1.7, 95% CI 1.6-1.9), and approximately 3 per 100 in women without preeclampsia. Early-onset preeclampsia conferred a substantially higher risk of cardiovascular, respiratory, central nervous system, renal, hepatic, and other morbidity. However, rates of obstetric trauma were significantly lower among women with preeclampsia. CONCLUSION Women with early-onset and late-onset preeclampsia have significantly higher rates of specific maternal morbidity compared with women without early-onset and late-onset disease. LEVEL OF EVIDENCE : II.
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