Maternal and perinatal outcomes in early and late preeclampsia
Great attention is paid to the study of early and late preeclampsia (PE). It is known that PE can lead to poor perinatal outcomes; however, the impact of the time of PE manifestation on maternal and perinatal outcomes has been understudied, making it difficult to predict pregnancy outcomes in this group of patients.Khlestova G.V., Karapetyan A.O., Shakaya M.N., Romanov A.Yu., Baev O.R.
Objective. To conduct a comprehensive study of the course of pregnancy, maternal and perinatal outcomes, and the neonatal period in patients with early and late PE.
Subjects and methods. The prospective cohort study enrolled 70 patients, including 40 patients with early PE (Group 1) and 30 patients with late PE (Group 2).
Results. Patients with early PE suffered from chronic hypertension 2.63 times more often and had a history of PE 5.25 times more frequently. In these patients, the average times of admission and delivery were shorter. The patients with early PE were noted to have placental insufficiency and fetal growth retardation 10.5 and 3.8 times more commonly.
There were no differences in the severity of hypertension and in the indicators of kidney function between the groups. The patients with early PE showed an increase in the level of liver enzymes (alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) and a decrease in the count of platelets, although their mean levels remained within the reference values. The cesarean delivery rate was not significantly different between the groups. However, the effect of the therapy was absent and the severity of placental insufficiency was increased in early PE.
The babies in the early PE group had lower birth weights (1895±1018 vs 2890±587 g; p < 0.001), one- and five-minute Apgar scores (7±1.2 vs 7.7±0.7; p < 0.001) and (8±1.0 vs 87±0.5; p < 0.001), respectively. In addition, the infants in this group frequently needed treatment in the neonatal intensive care unit.
Conclusion. The traditional approach is inadequate in predicting complications and perinatal outcomes in the two phenotypic variants of PE, as these classical clinical manifestations of this complication as hypertension and proteinuria are not decisive in characterizing the severity of the condition. The most important clinical feature of early PE is its earlier onset and long duration and the high frequency of metabolic disorders and placental insufficiency, which must be considered when determining the severity of the pathological process. In this connection, the perinatal outcomes in early PE were significantly poorer than those in late PE. It is necessary to continue investigations of the specific features of early PE and an expansion of a range of laboratory and instrumental methods for the early detection of characteristic homeostatic disorders.
Keywords
preeclampsia
early preeclampsia
late preeclampsia
perinatal outcomes
Supplementary Materials
- Table 1. The course of pregnancy in patients with preeclampsia
- Table 2. Levels of hepatic enzymes in patients with preeclampsia
- Table 3. Indications for cesarean delivery
- Figure. Fetal weight and discharge period in patients with early and late forms of preeclampsia
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Received 02.11.2016
Accepted 11.11.2016
About the Authors
Khlestova Galina Vladimirovna, the postgraduate student, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79647838076. E-mail: g_khlestova@oparina4.ru
Karapetyan Anna Ovikovna, the postgraduate student, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79057068481. E-mail: anne-89@mail.ru
Shakaya Marika Nygzarovna, the postgraduate student, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79037696160. E-mail: shaka-maka@mail.ru
Romanov Andrey Yurievich, clinical resident, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel. +79031589400. E-mail: romanov1553@yandex.ru
Baev Oleg Radomirovich, MD, Professor, Head of maternity department, Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381188. E-mail: o_baev@oparina4.ru
For citations: Khlestova G.V., Karapetyan A.O., Shakaya M.N.,
Romanov A.Yu., Baev O.R. Maternal and perinatal outcomes in early and late preeclampsia. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (6): 41-7. (in Russian)
http://dx.doi.org/10.18565/aig.2017.6.41-7
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