Severe Preeclampsia With and Without HELLP Differ With Regard to Placental Pathology

Abstract

Abstract-The aim of the present study was to evaluate the histopathology in placentas from patients with severe preeclampsia with and without hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. An additional aim was to compare the prevalence of infants born small for gestational age in the 2 groups. The study is retrospective and includes 178 women who have been diagnosed at the Karolinska University Hospital Huddinge or at the Free University Medical Center between 2000 and 2005 with severe preeclampsia. A total of 96 women had severe preeclampsia without signs of HELLP (preeclampsia group), whereas 82 fulfilled the criteria for having HELLP syndrome (HELLP group). Infarction (Pϭ0.014), intervillous thrombosis (PϽ0.001), and abruption (Pϭ0.002) were more common in the preeclampsia group than in the HELLP group. There was no statistically significant difference in the frequency of accelerated villous maturation (Pϭ0.61), decidual arteriopathy (Pϭ0.27), or chorioamnionitis (Pϭ0.61). Furthermore, there was a higher mean placental weight, adjusted for gestational age, in the Swedish HELLP material than in the preeclampsia group (PϽ0.001). Finally, mothers in the preeclampsia group gave birth significantly more often to small for gestational age babies than mothers suffering from HELLP syndrome (PϽ0.001). The histopathologic profile and the range of placental lesions were partly different in the preeclampsia and HELLP patients. Considering the central role that placenta seems to have in preeclampsia, the present result might suggest that different underlying pathogenetic mechanisms and courses can be in play in patients with preeclampsia and HELLP syndrome. Key Words: eclampsia Ⅲ gestational hypertension Ⅲ pregnancy hypertension Ⅲ preeclampsia Ⅲ pregnancy Ⅲ proteinuria Ⅲ women P reeclampsia (PE) affects 2% to 7% of healthy nulliparous women and is a major cause of maternal and fetal morbidity and mortality. 1 It is further subclassified into late-onset and early onset PE, severe and mild PE, and into a maternal and fetal syndrome. 2,3 The syndrome is characterized by hypertension and proteinuria, and a common fetal feature is intrauterine growth restriction. 2 Common pathological features in PE include small placentas with decidual arteriopathy, infarcts in central portions of the placenta, abruption placentae, and intervillous thrombosis. Arteriopathy is commonly found in PE, as well as intrauterine growth restriction, whereas the other findings are nonspecific. 4 -6 Hemolysis, elevated liver enzymes, and low platelets (HELLP) occurs in 20% of severe PE. The pathogenesis of this complication is not clear. Involvement of the coagulation system is seen in HELLP patients, which is not present in PE patients without HELLP. Symptoms include malaise, right upper quadrant tenderness, nausea, vomiting, edema, relative or absolute hypertension, and a varying degree of proteinuria. 7 Although the classical severe PE with manifest hypertension is more common in an African population, the HELLP syndrome is...

Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause

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