Predicting Risk of Chronic Hypertension in Women with Preeclampsia Based on Placenta Histology. A Prospective Cohort Study in Cuba.

Abstract

Background: Chronic hypertension is one of the major sequelae of preeclampsia with associated long term morbidity and mortality among previously normotensive women diagnosed with preeclampsia. We identified the predictors of developing this complication in women with preeclampsia admitted at the Carlos Manuel de Cèspedes Teaching Hospital in Cuba based on histological assessment of their placenta so as to guide the health care providers in early identification of the patients at risk for timely intervention against this vicious condition. Methods: A three-year prospective cohort study was conducted between March 2017 and March 2020. A cohort of 178 women diagnosed with preeclampsia was recruited and followed up at 12 weeks postpartum for chronic hypertension. Histological studies were done on their placenta following delivery and the respective result forms used to collect the data. Cox’s hazards regression model was applied to estimate the risk using STATA version 14.2.Results: Chorioamnionitis (HR=1.697, 95%CI: 1.443-3.416, p=0.038), villositary infarcts (HR=1.657, 95%CI: 1.264-2.848, p=0.048), intervillositary thrombus (HR=1.529, 95%CI: 1.231-3.197, p=0.020), and endarteritis (HR=1.242, 95%CI: 1.115-1.804, p=0.025) placental lesions were predictive of chronic hypertension at 12 weeks postpartum.Conclusion: Placental histology in women with preeclampsia is key towards improving the ability to diagnose and monitor those likely to develop chronic hypertension before its onset for timely intervention.