Clinical differences between early- and late-onset severe preeclampsia and analysis of predictors for perinatal outcome.
OBJECTIVE
To analyze the clinical differences between early- and late-onset cases of severe preeclampsia and to evaluate parameters that could help to predict perinatal outcome.


METHODS
Over a period of 6 years, all cases of severe preeclampsia (n=68) at our institution were included in a retrospective cohort analysis. Differences between early (<34 weeks, n=44) and late (≥34 weeks, n=24) onset of the disease were evaluated. Risk factors for low 5-min Apgar score (≤7), small-for-gestational-age (SGA) infants and neonatal acidosis (umbilical arterial pH <7.20) were identified and considered in a multiple logistic regression model.


RESULTS
Early- and late-onset severe preeclampsia differed from each other remarkably. Perinatal outcome was unfavorable in early-onset disease and seemed to be mainly a result of premature delivery and development of fetal growth restriction. Abnormal uterine Doppler velocimetry increased the risk of low 5-min Apgar values [odds ratio (OR) 8.0, P=0.012] and preterm birth <34+0 weeks (OR 17.9, P<0.001). An increased resistance of the umbilical artery was associated with a higher risk for SGA birth weight (OR 4.9, P=0.010).


CONCLUSIONS
Preeclampsia is a heterogeneous syndrome even if only severe cases were analyzed. Abnormal Doppler flow characteristics facilitated the identification of patients who were at increased risk for worse perinatal outcome.
Johannes
J
Stubert
Stefanie
S
Ullmann
Max
M
Dieterich
Doreen
D
Diedrich
Toralf
T
Reimer
D000138:Acidosis / Q000209:etiology; D000328:Adult; D001034:Apgar Score; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D017078:Laser-Doppler Flowmetry; D016015:Logistic Models; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000209:etiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging; D055815:Young Adult