Early onset and late onset preeclampsia-maternal and perinatal outcomes in a rural teritiary health center

Gomathy, E; Akurati, Lahari; Kannan, R

doi:10.18203/2320-1770.ijrcog20182333

Cited by 21 publications

(6 citation statements)

References 9 publications

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“…Of the 50 sPE participants, 34% (17/50) had EOPE. This is similar to findings of other studies: EOPE 27.6% vs LOPE 72.4% [67], and EOPE 35.5% vs LOPE 64.5% [68]. In susceptible women, EOPE occurs due to inadequate remodelling of spiral arteries while LOPE develops because the placenta overgrows its blood supply or becomes senescent.…”

Section: Discussionsupporting

confidence: 90%

The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy

2019

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Background The imbalance between circulating concentrations of anti- and pro-angiogenic factors is usually intense in preeclampsia with severe features (sPE). It is possible that pre-delivery circulating levels of angiogenic factors in sPE may be associated with postpartum antihypertensive drug requirements. Objective To determine the predictive association between maternal pre-delivery serum concentrations of angiogenic factors and the use of ≥3 slow- and/or a rapid-acting antihypertensive drug therapy in sPE on postpartum days zero to three following caesarean delivery. Study design Women with sPE (n = 50) and normotensive pregnancies (n = 90) were recruited prior to childbirth. Serum samples were obtained from each participant < 48 hours before delivery to assess the concentrations of placental growth factor (PIGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) using the Roche Elecsys platform. Each participant was followed up on postpartum days zero, one, two and three to monitor BP and confirm antihypertensive treatment. The optimal cut-off thresholds of sFlt-1/PIGF ratio from receiver operating characteristic curve predictive of the antihypertensive therapy were subjected to diagnostic accuracy assessment. Results The majority 58% (29/50) of sPE had multiple severe features of preeclampsia in the antenatal period with the commonest presentation being severe hypertension in 88% (44/50) of this group, followed by features of impending eclampsia which occurred in 42% (21/50). The median gestational age at delivery was 38 (Interquartile range, IQR 1) vs 36 (IQR 6) weeks, p < 0.001 in normotensive and sPE groups respectively. Notably, the median sFlt-1/PIGF ratio in normotensive and sPE groups were 7.3 (IQR 17.9) and 179.1 (IQR 271.2) respectively, p < 0.001. Of the 50 sPE participants, 34% (17/50) had early-onset preeclampsia. The median (IQR) of sFlt-1/PIGF in the early- and late-onset preeclampsia groups were 313.52 (502.25), and 166.59(195.37) respectively, p = 0.006. From postpartum days zero to three, 48% (24/50) of sPE received ≥ 3 slow- and/or a rapid-acting antihypertensive drug. However, the daily administration of ≥ 3 slow- and/or a rapid-acting antihypertensive drug in sPE were pre-delivery 26% (13/50), postpartum day zero 18% (9/50), postpartum day one 34% (17/50), postpartum day two 24% (12/50) and postpartum day three 20% (10/50). In sPE, the pre-delivery sFlt-1/PIGF ratio was predictive of administration of ≥3 slow- and/or a rapid-acting antihypertensive drug on postpartum days zero, one and two with the optimal cut-off ratio being ≥315.0, ≥181.5 and ≥ 267.8 respectively (sensitivity 72.7–75.0%, specificity 64.7–78.6%, positive predictive value 40.0–50.0% and negative predictive value 84.6% - 94.3%). The predictive performance of sFlt-1/PIG ratio on postpartum day 3 among the sPE was no...

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Section: Discussionsupporting

confidence: 90%

The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy

2019

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“…Preeclampsia has been widely considered as an independent risk factor that largely contributes to IUGR [41]. In the current research, the prevalence of IUGR (19 %) was slightly lower than the rates previously reported by some studies [42] and higher than others [43]. In 2015, Wicaksono et al, found that LOP has no effect on the incidence of IUGR (p = 0.53; PR = 1.40; 95% CI = 0.48-4.08) [44].This can be explained by the fact that in LOP there is no or slight alteration of spiral arteries diameter which results in placental hypoperfusion in some but not all cases [13].…”

Section: Discussioncontrasting

confidence: 66%

Evaluating the Predictive Value of Fetal Doppler Indices and Neonatal Outcome in Late-onset Preeclampsia With Severe Features: a Cross-sectional Study in a Resource-limited Setting

Moawad¹,

Tammam²,

Mosaad³

et al. 2021

Preprint

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Background: Preeclampsia constitutes a major health problem with substantial maternal and perinatal morbidity and mortality. The aim of this study was to detect the diagnostic efficacy of fetal Doppler in predicting adverse outcomes in severe late onset preeclampsia (LOP). Methods: A prospective study was conducted among childbearing women who presented with severe LOP and matched controls. Umbilical artery (UA) and middle cerebral artery (MCA) Doppler indices including pulsatility index (PI), resistance index (RI), systolic/diastolic ratio (S/D) and cerebroplacental ratio (CPR) were measured.Results: All UA indices were significantly higher in the case group compared to the controls (p < 0.001). UA PI and RI were significantly correlated with all neonatal adverse outcomes except cord pH status (p < 0.05). Abnormal CPR was the most sensitive index that positively correlated with intrauterine growth retardation (IUGR), low 5- minute Apgar score and neonatal intensive care unit admission (79 %, 72.8 % and 73.3 %, respectively). In the same context, Abnormal UA PI and RI represented the most specific tool for predicting IUGR, low 1- and 5- minutes Apgar score with positive predictive values were 52 %, 87 % and 57 %, respectively.Conclusion: In severe LOP, UA Doppler remains the preferential indicator for adverse birth outcomes with CPR is the best index that could be solely used for predicting such outcome.

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“…Our study findings are also different from Gomathy et al where 53.3% patients in EOPE and 58,6% in LOPE group were delivered by caesarean section. 16 We did not find statistically significant difference in SGA and NND between the two groups.This is in contrast with Gomathy et al where 91.6% foetuses were SGA in EOPE as compared to 54.8% in LOPE.(p0.0001). 16 Bozdag et al also found that more foetuses are SGA in EOPE group as compared to LOPE (p=0.001).…”

Section: Discussioncontrasting

confidence: 56%

“…16 We did not find statistically significant difference in SGA and NND between the two groups.This is in contrast with Gomathy et al where 91.6% foetuses were SGA in EOPE as compared to 54.8% in LOPE.(p0.0001). 16 Bozdag et al also found that more foetuses are SGA in EOPE group as compared to LOPE (p=0.001). 18 In addition, Bozdag et al found 30% neonatal deaths in preeclampsia before 34 weeks as compared to 4% afterwards (p=0.01).…”

Section: Discussioncontrasting

confidence: 56%

“…Gomathy et al however found EOPE more in multi gravidas and LOPE more in primigravidas.This difference can be coincidental because age range and sample size of our study matches with the Gomathy et al and comorbidities have been excluded in both cases. 16 The finding of preeclampsia more in multigravidas is again in contrast with the findings of Hernandez et al who found that risk of preeclampsia was 4.1% in first pregnancy and 1.7% in the following ones. 17 Difference in population characteristic may account for these changes in results.…”

Section: Discussionmentioning

confidence: 68%

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Comparison of Adverse Fetomaternal Outcome in Early and Late Onset Pre Eclampsia

Gohar

Syed

2021

JPMI

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Objective: To compare adverse feto-maternal outcome between women with early and late onset preeclampsia.Methodology: This cross sectional study was conducted in Gynecology and Obstetrics and Gynecology Department, Lady Reading Hospital, Peshawar from March 2016 to September 2016. A total of 254 patients having singleton pregnancy of more than 20 weeks were included. Week 34 was used as a cutoff to classify patients into Early Onset Preeclampsia (EOPE) and Late Onset Preeclampsia (LOPE). All the subjects were followed up till one week after delivery to compare adverse fetomaternal outcome. SPSS version 25 was used for data analysis.Results: Out of 254 patients, 172 (67.7%) patients had LOPE while 82 (32.3%) presented with EOPE. The mean Body Mass Index (BMI) for EOPE and LOPE was 25.25±1.70kg/m 2 and 25.97±2.03kg/m 2 , respectively. Most of the patients were multigravida in both groups, 43 (52.4%) in EOPE and 122 (70.93%) in LOPE. Preterm birth was more common in the EOPE (n=49, 59.75%) as compared to LOPE (n=60, 34.88%) with a p-value of ≤0.05. LOPE group had more cesarean sections (n=62, 36.02%) than EOPE (n=16, 19.53%) with a p-value of ≤0.05. Neonatal Intensive Care Unit (NICU) admissions were more common in EOPE group (60.92%) as compared to LOPE (41.82%) having a p-value of ≤0.05. Neonatal deaths and small for gestational age was found to be insignificant in the two groups. Conclusion:Preterm birth and NICU admissions were more common in EOPE while cesarean section was more commonly done in LOPE.

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Early onset and late onset preeclampsia-maternal and perinatal outcomes in a rural teritiary health center

Cited by 21 publications

References 9 publications

The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy

The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy

Evaluating the Predictive Value of Fetal Doppler Indices and Neonatal Outcome in Late-onset Preeclampsia With Severe Features: a Cross-sectional Study in a Resource-limited Setting

Comparison of Adverse Fetomaternal Outcome in Early and Late Onset Pre Eclampsia

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