Characterization of Atypical Preeclampsia

Abstract

Objective: To characterize patients with atypical preeclampsia (PE), in relation to socio-demographic characteristics, clinical presentation, maternal complications and perinatal outcome. Materials and Methods: Between July 1, 2011 and November 30, 2013, a cohort was created of women attended at a Obstetric High-dependency Unit who met criteria for atypical PE: gestational hypertension with severe hypertension or symptoms or laboratory signs suggestive of microangiopathy/hemolysis; normotensive proteinuria with the presence of symptoms or laboratory signs suggestive of microangiopathy/hemolysis; presence of PE or eclampsia or HELLP syndrome appearing after 48 h postpartum, and, PE or eclampsia appearing before 20 weeks of pregnancy. Results: A total of 200 women fulfilling criteria for atypical PE, were included: 61.5% corresponded to non-proteinuric gestational hypertension, 35.5% to normotensive proteinuria and 3% to PE/eclampsia in late postpartum. Criteria for severe maternal morbidity were present in 12% of the cases and there were no maternal deaths. There were 6 perinatal deaths. Conclusion: Atypical preeclampsia is a type of preeclampsia not fully recognized that is associated with maternal and neonatal morbidity, mainly related to smallness-for-gestational-age and low birth weight. Vasospasm symptoms are a key element to detect this condition.

Does pre‐eclampsia without proteinuria lead to different pregnancy outcomes than pre‐eclampsia with proteinuria?

“…Although the frequency of PE increased with the change in the diagnostic criteria for the condition, the pregnancy outcomes for those with the new diagnosis of PE without proteinuria are about as poor as the traditional diagnosis of PE with proteinuria. Several studies have examined the prognosis for PE without proteinuria . Homer et al .…”

Obstetric Disorders in the ICU

“…17,19,20 Accordingly, approximately 50% of patients present with severe systolic hypertension and 25% with severe diastolic hypertension 17 ; however, 11% of patients do not present with hypertension. 17,21 As hypertensive disorders of pregnancy are the leading obstetric cause of admission to the ICU, 1 physicians should still look for other signs and symptoms of severe preeclampsia even when hypertension is absent.…”

No Hypertensive Disorder of Pregnancy; No Preeclampsia-eclampsia; No Gestational Hypertension; No Hellp Syndrome. Vascular Disorder of Pregnancy Speaks for All

“…Although the exact mechanism regarding the induction of this disease remains enigmatic, vascular disorder characterized by generalized endothelial damage and vasospasm is a well-known pathology resulting in systemic complications during pregnancy ( 2 – 4 ). Apart from the pathogenesis, there is also uncertainty in its natural course, diagnosis and screening methods ( 3 ).…”

“…Neither hypertensive pregnancy disorders nor the current sub-classifications (chronic hypertension, preeclampsia-eclampsia, gestational hypertension, superimposed preeclampsia on chronic hypertension) is inclusive as these terminologies only partly describe the disease's clinical manifestations. Since endothelial damage is the unifying pathology behind all the clinical manifestations ( 2 – 4 ), vascular disorder of pregnancy (VDP) is a simplified but comprehensive terminology to describe the spectrum of the disease. Although the timing of occurrence varies, all the systemic complications (cardiovascular, renal, hematologic, intracranial, hepatic, pulmonary and uteroplacental) are the consequences of the generalized endothelial vascular damage resulting in vasospasm.…”

“…Some systemic complications occur late in the disease process but may appear early and present a puzzle for clinicians. For example, eclampsia and HELLP syndrome (hemolytic anemia, elevated liver enzymes, low platelet count) ( 4 , 8 ) are expected to occur in advanced disease but can appear first. In other cases, the first disease manifestation may be hypertension, renal dysfunction, hematologic abnormalities, increased intracranial pressure or hepatic disorder.…”