New definition and classification of “Hypertensive Disorders of Pregnancy (HDP)”

Watanabe, Kazushi; Matsubara, Keiichi; Nakamoto, Osamu; Ushijima, Junko; Ohkuchi, Akihide; Koide, Kazunori; Makino, Shintaro; Mimura, Kazuya; Morikawa, Mamoru; Naruse, Katsuhiko; Nohira, Tomoyoshi; Metoki, Hirohito; Takeda, Satoru; Takagi, Kenjiro; Yamasaki, Mineo; Ichihara, Atsuhiro; Kimura, Tadashi; Saito, Shigeru

doi:10.14390/jsshp.hrp2017-018

Cited by 16 publications

(11 citation statements)

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“…Low platelet count is considered a sign of maternal organ damage related with pre‐eclampsia; however, the threshold of low platelet count remains controversial. While the new Japanese classification and ISSHP guidelines consider <150 × 10 9 /L as abnormal, the ACOG guidelines consider <100 × 10 9 /L as abnormal . We demonstrated that a platelet count of <100 × 10 9 /L increased the risk of NICU admission and preterm delivery.…”

Section: Discussionmentioning

confidence: 74%

“…The pathogenesis of pre‐eclampsia is inadequate placental trophoblast invasion into the maternal uterine spiral arteries followed by ensuing endothelial damage . Based on the pathogenesis of pre‐eclampsia, the new Japanese criteria added maternal organ damage into a feature of severe pre‐eclampsia . We aimed to evaluate the independent effect of maternal organ damage and severe hypertension on perinatal outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The new Japanese classification and ISSHP guidelines include uteroplacental dysfunction in the criteria to diagnose pre‐eclampsia; however, ACOG guidelines exclude uteroplacental dysfunction from the criteria because FGR is managed similarly in women with and without pre‐eclampsia . Although FGR has many etiologies, abnormal development of the uteroplacental circulation is a major etiology .…”

Section: Discussionmentioning

confidence: 99%

“…The new Japanese classification and the ISSHP guidelines classify patients with uteroplacental dysfunction as pre‐eclamptic even if proteinuria is not detected . However, the ACOG guidelines do not consider utero placental dysfunction to diagnose pre‐eclampsia .…”

Section: Introductionmentioning

confidence: 99%

“…The ACOG guidelines define an abnormal platelet count as less than 100 × 10 9 /L; however, the Japanese and ISSHP guidelines consider a platelet count of <150 × 10 9 /L as a sign of organ damage …”

Section: Introductionmentioning

confidence: 99%

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Increase in the number of patients diagnosed using the new classification of hypertensive disorders of pregnancy in Japan

Mayama

Morikawa

Umazume

et al. 2019

J of Obstet and Gynaecol

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Aim This study aimed to examine how the number of patients diagnosed with pre‐eclampsia increased according to the Japanese classification of hypertensive disorders of pregnancy (HDP) that was revised in 2018. The effect of new classification on perinatal outcomes was also analyzed. Methods We enrolled 181 women with HDP who delivered at Hokkaido University Hospital between February 2011 and December 2017. All women were reclassified on the basis of the new classification, in which proteinuria was not required to diagnose pre‐eclampsia in patients with maternal organ damage. The number and reasons of reclassification and the admission rate to the neonatal intensive care unit (NICU) and gestational age (GA) at the onset of HDP and at delivery were analyzed. Results In this cohort, 17 (9.4%) of 181 women with HDP were reclassified. Low platelet count (41.2%) and uteroplacental dysfunction (41.2%) were the two main causes for reclassification. GA at the onset of HDP (33.6 [29.9–36.1] weeks vs 37.4 [35.7–38.4] weeks; P < 0.001) and at delivery (35.9 [32.4–37.3] weeks vs 38.1 [37.3–39.6] weeks; P < 0.001) were significantly earlier in women with reclassification than women without reclassification. The NICU admission rate was higher in women with reclassification than women without reclassification (70.6% vs 20.4%; P < 0.001). Conclusion Almost 10% of pregnant women were newly diagnosed with pre‐eclampsia as per the new Japanese classification of HDP. Women with reclassification as pre‐eclampsia had a greater risk of preterm delivery and NICU admission than those who were not reclassified.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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