title: Maternal and feto-placental phenotypes of early-onset severe preeclampsia.
abstract: OBJECTIVE
  To characterize maternal and feto-placental phenotypes of severe preeclampsia that trigger early-onset delivery.
  
  
  METHODS
  A retrospective cohort review of pregnant women receiving care from 2000 to 2010. Subjects with early-onset severe preeclampsia delivering between 20 and 32 weeks were identified excluding multiple gestations or major anomalies. We defined indications for delivery as maternal (i.e. severe headache or abnormal laboratory parameters), feto-placental (i.e. non-reassuring tracing) or mixed (i.e. both maternal and feto-placental factors). To characterize the groups, demographic, clinical, laboratory, ultrasound and pathology data were abstracted. Statistical analysis was conducted.
  
  
  RESULTS
  We identified 164 subjects meeting inclusion criteria. Indications for delivery were maternal (57.3%), feto-placental (29.9%) or mixed (12.8%). Compared to neonates delivered for maternal indications, birthweight was significantly lower among neonates delivered for feto-placental or mixed indications (p < 0.001). While placental findings were largely similar between groups, abnormal cord insertion was more common in subjects delivered for feto-placental factors (p = 0.02). Women delivered for maternal indications had more significant lab abnormalities than women delivered for feto-placental or mixed indications.
  
  
  CONCLUSIONS
  In attempting to classify early-onset severe preeclampsia by delivery indication, we found patterns to suggest that feto-placental and maternal phenotypes of disease may have distinct pathophysiologic underpinnings.
authors.affiliation: a Department of Obstetrics & Gynecology , Brigham & Women's and Massachusetts General Hospitals , Boston , MA , USA .
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Pilliod
authors.affiliation: b Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine , Columbia University , New York , NY , USA , and.
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Feinberg
authors.affiliation: c Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine , Oregon Health & Sciences University , Portland , OR , USA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Burwick
mesh_terms: D000037:Abruptio Placentae; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001724:Birth Weight; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D017359:HELLP Syndrome; D006261:Headache / Q000150:complications; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D010641:Phenotype; D010976:Platelet Count; D011225:Pre-Eclampsia; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D014469:Umbilical Arteries / Q000000981:diagnostic imaging; D014470:Umbilical Cord / Q000002:abnormalities
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Disease phenotype; HELLP; histopathology; obstetrics; placenta