Late first-trimester placental disruption and subsequent gestational hypertension/preeclampsia.
OBJECTIVE
To evaluate the potential relationship between placental disruption in weeks 13 and 14 and the subsequent development of gestational hypertension or preeclampsia.


METHODS
Using subjects recruited during a randomized trial funded by the National Institute of Child Health and Human Development, which compared early amniocentesis and late transabdominal chorionic villus sampling (CVS) in weeks 13 and 14, rates of gestational hypertension and preeclampsia were compared between cases with varying degrees of placental disruption.


RESULTS
A total of 3,698 of 3,775 randomized subjects had cytogenetically normal pregnancies and were analyzed. A significantly higher rate of hypertension/preeclampsia was observed in the late CVS group (5.4%, n = 1,878) compared with the early amniocentesis cohort (3.5%, n = 1,820; P = .005). This difference persisted after controlling for maternal age, body mass index, parity, previous preterm delivery, smoking, and fetal gender. Early amniocentesis cases were further stratified on the basis of whether the placenta had been penetrated (n = 460) or not (n = 1,360). Risk of hypertensive complications was lowest if the placenta was not traversed (3.4%), greater with placental penetration (3.9%), and highest when the placenta was directly sampled during CVS (5.4%, P = .02).


CONCLUSIONS
We hypothesize that focal disruption of the placenta at 13-14 weeks may increase the risk of hypertension/preeclampsia. These findings provide support for the theory that disturbances in early placentation lead subsequently to maternal hypertension.
Silver
Richard K
RK
Evanston Hospital of Northwestern University Medical School, Evanston, Illinois 60201, USA. r-silver@northwestern.edu
Wilson
R Douglas
RD
Philip
John
J
Thom
Elizabeth A
EA
Zachary
Julia M
JM
Mohide
Patrick
P
Mahoney
Maurice J
MJ
Simpson
Joe L
JL
Platt
Larry D
LD
Pergament
Eugene
E
Hershey
Douglas
D
Filkins
Karen
K
Johnson
Anthony
A
Wapner
Ronald J
RJ
Jackson
Laird G
LG
D000649:Amniocentesis / Q000009:adverse effects*; D015193:Chorionic Villi Sampling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000209:etiology*; D009339:Needles; D011225:Pre-Eclampsia / Q000209:etiology*; D011247:Pregnancy; D011261:Pregnancy Trimester, First