Maternofetal outcomes in early versus late onset pre-eclampsia: a comparative study

Authors

  • Poornima Shankar Department of Obstetrics and Gynecology, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
  • Kavitha Karthikeyan Department of Obstetrics and Gynecology, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
  • Amrita Priscilla Nalini Department of Obstetrics and Gynecology, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
  • Sindhura M. Department of Obstetrics and Gynecology, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
  • Gowtham Kim Department of Obstetrics and Gynecology, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20190282

Keywords:

Early onset, Fetal outcome, Late onset pre-eclampsia, Maternal outcome

Abstract

Background: Preeclampsia is being increasingly recognized as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset disease occurring at 34 or more weeks of gestation. Early-onset and late-onset pre-eclampsia are found to have different implications for the mother and neonate. The aim of this study is to compare the risk factors, maternal and fetal outcomes in early (<34 weeks) versus late (≥34weeks) onset preeclampsia.

Methods: 208 patients diagnosed with pre-eclampsia in Chettinad Academy of Research and Education over a period of three years (From January 2014 to December 2016) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on risk factors, maternal and fetal outcomes were collected and analyzed using Chi Square and Fisher’s test and compared.

Results: The overall preeclampsia rate was 6.3%. Early onset and late onset were 34.6% and 65.3% respectively and the rate increased with increasing gestational age.35.3% of patients with late onset preeclampsia and 55.6% patients of early onset type required more than one drug which is a statistically significant difference. Proteinuria more than 3gm/l/day was significantly more in late onset preeclampsia than in early onset preeclampsia. 55.5% of patients with early onset pre-eclampsia required MgSO4 when compared to 17.4%. There was no statistically significant difference in the rate of caesarean section (61.1% vs 73.5%). Altered coagulation profile was significantly more in early onset preeclampsia (11.1%). The incidence of oligohydramnios, SGA and low APGAR at 5 minutes of birth were significantly high in early onset pre-eclampsia when compared to late onset type.

Conclusions: Patients with early onset pre-eclampsia are found to have significantly higher rates of specific maternal and fetal morbidity when compared to the late onset type.

References

Khodzhaeva ZS, Kogan YA, Shmakov RG, Klimenchenko NI, Akatyeva AS, Vavina OV, et al. Clinical and pathogenetic features of early-and late-onset pre-eclampsia. J Maternal-Fetal Neonat Med. 2016;29(18):2980-6.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Global Health. 2014;2(6):e323-33.

Von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertension Preg. 2003;22(2):143-8.

Chen Y, Huang Y, Jiang R, Teng Y. Syncytiotrophoblast‐derived microparticle shedding in early‐onset and late‐onset severe pre‐eclampsia. Int J Gynecol Obstet. 2012;119(3):234-8.

Kucukgoz Gulec U, Ozgunen FT, Buyukkurt S, Guzel AB, Urunsak IF, Demir SC, et al. Comparison of clinical and laboratory findings in early-and late-onset preeclampsia. J Maternal-Fet Neonat Med. 2013;26(12):1228-33.

Raymond D, Peterson E. A critical review of early-onset and late-onset preeclampsia. Obstet Gynecol Survey. 2011;66(8):497-506.

Ogge G, Chaiworapongsa T, Romero R, Hussein Y, Kusanovic JP, Yeo L, et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J Perinatal Med. 2011;39(6):641-52.

Cunningham FG, Williams J Whitridge. Williams textbook of obstetrics 23rd edition New York: McGraw-Hill;2010:707.

Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease. Am J Obstet Gynecol. 2013;209(6):544-e1.

Churchill D, Duley L, Thornton J, Jones L. Interventionist versus expectant care for severe pre-eclampsia between 24-and 34-weeks’ gestation. Cochrane Library. 2013;7:CD003106.

Lisonkova S, Sabr Y, Mayer C, Young C, Skoll A, Joseph KS. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstet Gynecol. 2014;124(4):771-81.

Madazli R, Yuksel MA, Imamoglu M, Tuten A, Oncul M, Aydin B, et al. Comparison of clinical and perinatal outcomes in early-and late-onset preeclampsia. Archives Gynecol Obstetr. 2014;290(1):53-7.

Elmugabil A, Rayis DA, Ahmed MA, Adam I, Gasim GI. O blood group as risk factor for preeclampsia among Sudanese women. Open access Macedonian J Med Sci. 2016;4(4):603.

Downloads

Published

2019-01-25

Issue

Section

Original Research Articles