The impact of the definition of preeclampsia on disease diagnosis and outcomes: a retrospective cohort study

Reddy, Maya; Fenn, Sarah; Rolnik, Daniel L.; Mol, Ben W.; Costa, Fabrício da Silva; Wallace, Euan; Palmer, Kirsten

doi:10.1016/j.ajog.2020.08.019

Cited by 32 publications

(30 citation statements)

References 29 publications

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“…Previous studies of the relationship between PE definitions and outcomes have questioned the value of a broad (vs traditional) definition of PE based on concerns that a low-risk population is being identified by the broad definition, at least at gestational ages preterm. 24,25,27 However, adverse maternal and neonatal outcome rates have been well above the baseline rates, 24,27 similar to our findings, suggesting that the use of a broad definition with uteroplacental function, as defined by EFW, Dopplers, and angiogenic imbalance, is clinically useful. In addition, the independent value of routine maternal laboratory test results and FGR were recently demonstrated 27 ; although the role of headache and visual symptoms was not demonstrated, these have been shown to have prognostic value in the absence of laboratory testing, such as in the self-monitored setting in high-income countries or in low-resource settings where most women and babies die of PE.…”

Section: Comparison With Published Literaturesupporting

confidence: 87%

Impact of new definitions of preeclampsia at term on identification of adverse maternal and perinatal outcomes

Lai

Syngelaki

Nicolaides

et al. 2021

American Journal of Obstetrics and Gynecology

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BACKGROUND: Any definition of preeclampsia should identify women and babies at greatest risk of adverse outcomes. OBJECTIVE: This study aimed to investigate the ability of the American College of Obstetricians and Gynecologists and International Society for the Study of Hypertension in Pregnancy definitions of preeclampsia at term gestational age (!37 0/7 weeks) to identify adverse maternal and perinatal outcomes. STUDY DESIGN: In this prospective cohort study at 2 maternity hospitals in England, women attending a routine hospital visit at 35 0/7 to 36 6/7 weeks' gestation underwent assessment that included history; ultrasonographic estimated fetal weight; Doppler measurements of the pulsatility index in the uterine, umbilical, and fetal middle cerebral arteries; and serum placental growth factoretoesoluble fms-like tyrosine kinase-1 ratio. Obstetrical records were examined for all women with chronic hypertension and those who developed new-onset hypertension, with preeclampsia (de novo or superimposed on chronic hypertension) defined in 5 ways: traditional, based on new-onset proteinuria; American College of Obstetricians and Gynecologists 2013 definition; International Society for the Study of Hypertension in Pregnancy maternal factors definition; International Society for the Study of Hypertension in Pregnancy maternal factors plus fetal death or fetal growth restriction definition, defined according to the 35 0/7 to 36 6/7 weeks' gestation scan as either estimated fetal weight <3rd percentile or estimated fetal weight at the 3rd to 10th percentile with any of uterine artery pulsatility index >95th percentile, umbilical artery pulsatility index >95th percentile, or middle cerebral artery pulsatility index <5th percentile; and International Society for the Study of Hypertension in Pregnancy maternal-fetal factors plus angiogenic imbalance definition, defined as placental growth factor <5th percentile or soluble fms-like tyrosine kinase-1etoeserum placental growth factor >95th percentile. Detection rates for outcomes of interest (ie, severe maternal hypertension, major maternal morbidity, perinatal mortality or major neonatal morbidity, neonatal unit admission !48 hours, and birthweight <10th percentile) were compared using the chi-square test, and P<.05 was considered significant.

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Section: Comparison With Published Literaturesupporting

confidence: 87%

Impact of new definitions of preeclampsia at term on identification of adverse maternal and perinatal outcomes

Lai

Syngelaki

Nicolaides

et al. 2021

American Journal of Obstetrics and Gynecology

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“…PE is gestational hypertension accompanied by one or more of the following new-onset conditions, on or after 20 weeks of gestation: proteinuria or other maternal organ dysfunction, including acute kidney injury; liver involvement with or without right upper quadrant or epigastric abdominal pain; neurological complications; hematological complications; and uteroplacental dysfunction [ 12 ]. However, implementation of the evolved definitions of PE remains controversial [ 13 ]. As systemic symptoms can occur in PE, a confident diagnosis of PE in women with slightly higher BP is sometimes challenging.…”

Section: Discussionmentioning

confidence: 99%

“…As systemic symptoms can occur in PE, a confident diagnosis of PE in women with slightly higher BP is sometimes challenging. Although edema is not considered a diagnostic criterion [ 12 , 13 ], its appearance in several organs, such as the heart, lung, coelomic cavities, and subcutaneous tissue, primarily induced by increased vascular permeability and cardiac dysfunction, should raise suspicion of PE [ 2 , [5] , [6] , [7] ]. The patient in this case presented with right upper abdominal pain and headache, and while both HELLP syndrome and intracranial hemorrhage were suspected initially, the laboratory tests and brain CT findings did not confirm the presence of either.…”

Section: Discussionmentioning

confidence: 99%

Gallbladder wall thickening in a woman with postpartum preeclampsia: A case report

Murata

Yoshimoto

Shibano

et al. 2022

Case Reports in Women's Health

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Background Preeclampsia (PE) is hallmarked by dysfunction of various organs; therefore, its diagnosis can be challenging, especially when patients present with right upper abdominal pain. Herein, we present a case of postpartum gallbladder wall thickening (GBWT) that led to a diagnosis of PE, rather than hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome or gallbladder and biliary disease. Case Presentation A 31-year-old postpartum woman presented with a fever, hypertension, headache, and right upper abdominal pain. HELLP syndrome and intracranial hemorrhage were initially suspected, due to the combination of symptoms and elevated levels of aspartate transaminase, alanine transaminase, and lactate dehydrogenase. However, hemolysis and thrombocytopenia were absent, and a computed tomography (CT) scan of the head did not indicate the presence of intracranial hemorrhage. Further, transabdominal ultrasound and CT revealed GBWT (edematous gallbladder); CT also revealed an enlarged heart, lung edema, pleural effusion, and ascites. Thus, PE, rather than HELLP syndrome or gallbladder or biliary disease, was diagnosed based on gestational hypertension and proteinuria, new-onset headache, liver dysfunction, and edema in several organs, including the lung. Nicardipine treatment quickly improved hypertension and headache, and, over time, the patient's urination increased, and edema subsided throughout the body. Furthermore, laboratory results improved, and the patient was discharged on postpartum day 11. Conclusion Postpartum gallbladder wall thickening can be a diagnostic sign of PE.

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“…The cohort was followed till delivery to know the pregnancy outcome. During follow-up, subjects who developed preeclampsia were categorised based on ACOG guidelines (11). For the genetic analysis cord blood was collected post-partum from preeclampsia and from normotensive women.…”

Section: Methodsmentioning

confidence: 99%

Relevance of Placental protein 13 in combination with Xanthine oxidase activity andAsymmetric dimethylargininein early prediction of Preeclampsia with an evidence of LGALS13 gene promoter variant

Gadde¹,

Dayanand²,

Sharath³

et al. 2021

Biomedicine

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Introduction and Aim:Preeclampsia is a pregnancy specific hypertensive disorder and its complications are associated with maternal morbidity and mortality. The intention of the study is to determine early placental and endothelial dysfunction markers in first and second trimesters of pregnancy for the prediction of preeclampsia. Materials and Methods:Study design was prospective which enrolled 268 pregnant women during their first ante-natal visit. Blood samples were analysed for Placental protein13 (PP13), Asymmetric dimethyl arginine (ADMA) by ELISA and Xanthine oxidase (XO) activity by colorimetric assay. On follow-up, 22 subjects developed preeclampsia, 12 had spontaneous abortions and the rest remained normotensive till delivery. PP13 gene, LGALS13 was sequenced in preeclampsia cases to know if any polymorphism was present. Results:Results were analysed by Wilcoxon Signed Ranks test know the level of statistical significance, correlation analysis by Spearman’s correlation and diagnostic performance of the measured parameters was assessed by receivers operating characteristic (ROC) curve. Pregnant women who developed Preeclampsia had low PP13 levels in first trimester and elevated ADMA in second trimester (p<0.001). Gene sequencing of LGALS13 in preeclampsia showed -98C/A SNP at promoter region. ROC curve showed AUC for first trimester PP13 (0.932), second trimester PP13 (0.955) second trimester XO activity (0.967) and second trimester ADMA (1.000). Conclusion: The results suggest that oxidative stress, placental and endothelial dysfunction biomarkers would be helpful for early prediction of preeclampsia.

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The impact of the definition of preeclampsia on disease diagnosis and outcomes: a retrospective cohort study

Cited by 32 publications

References 29 publications

Impact of new definitions of preeclampsia at term on identification of adverse maternal and perinatal outcomes

Impact of new definitions of preeclampsia at term on identification of adverse maternal and perinatal outcomes

Gallbladder wall thickening in a woman with postpartum preeclampsia: A case report

Relevance of Placental protein 13 in combination with Xanthine oxidase activity andAsymmetric dimethylargininein early prediction of Preeclampsia with an evidence of LGALS13 gene promoter variant

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