Maternal and Perinatal Outcomes of Early-onset and Late-onset Preeclampsia at a Tertiary Center Hospital
Muhammad IA Akbar, Hapsari Kinanti, Ernawati E Ernawati, Pudji Lestari
Citation Information :
Akbar MI, Kinanti H, Ernawati EE, Lestari P. Maternal and Perinatal Outcomes of Early-onset and Late-onset Preeclampsia at a Tertiary Center Hospital. J South Asian Feder Obs Gynae 2021; 13 (5):338-342.
Aim: Preeclampsia is still a major health problem in Indonesia, that causes maternal and perinatal morbidity and mortality. This study compares the maternal and perinatal outcomes between early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE) at a tertiary care center in Indonesia during 2016.
Materials and methods: This cross-sectional study includes 102 patients with preeclampsia. Preeclampsia was divided based on the gestational age: <34 weeks as EO-PE and ≥34 weeks as LO-PE. The primary outcomes were maternal and perinatal outcomes.
Results: The incidence of all preeclampsia in this study was 12.5% during 2016. EO-PE is associated with a longer length of stay compared to LO-PE [8 (5) vs 6 (3); p <0.0001]. Other maternal outcomes, such as mode of delivery, maternal death, eclampsia, HELLP syndrome, gestational diabetes mellitus, and lung edema, were not significantly different. EO-PE was also correlated with worse perinatal outcomes, such as preterm birth (97.6 vs 38%; p <0.001; OR 66.9; 95% CI: 8.49–527.1), baby birth weight [1,525 (763) vs 2,650 (650); p <0.001], baby birth length [41 (6) vs 47 (4); p <0.001], lower Apgar score at first minute [5 (5) vs 7 (2); p <0.0001], and lower Apgar score at fifth minute [7 (5) vs 8 (2); p <0.0001].
Conclusion: EO-PE is associated with worse maternal and perinatal outcomes compared to LO-PE. The presence of EO-PE should be responded to with tight monitoring and early intervention to reduce the risk of maternal and perinatal complications.
Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE Open 2019;7:1–15. DOI: 10.1177/2050312119843700.
Akbar MIA, Adibrata MA, Aditiawarman, et al. Maternal and perinatal outcome related to severity of chronic hypertension in pregnancy. Pregnancy Hypertens 2019;16:154–160. DOI: 10.1016/j.preghy.2019.04.007.
Roberts JM, Druzin M, August PA, et al. ACOG guidelines: hypertension in pregnancy. American College of Obstetricians and Gynecologists; 2012. 1–100 p.
Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension 2018;72(1):24–43. DOI: 10.1161/HYPERTENSIONAHA.117.10803.
Gomathy E, Akurati L, Radhika K. Early onset and late onset preeclampsia-maternal and perinatal outcomes in a rural teritiary health center. Int J Reprod Contracept Obstet Gynecol 2018;7(6):2266. DOI: 10.18203/2320-1770.ijrcog20182333.
Ernawati, Gumilar E, Kuntoro, et al. Expectant management of preterm preeclampsia in Indonesia and the role of steroids. J Matern Fetal Neonatal Med 2016;29(11):1736–1740. DOI: 10.3109/14767058.2015.1059815.
Kementerian Kesehatan Republik Indonesia. 2014. Infodatin Data and Information Center Ministry of Health Republic of Indonesia.
Tyas BD, Lestari P, Akbar MIA. Maternal perinatal outcomes related to advanced maternal age in preeclampsia pregnant women. J Family Reprod Health 2020;13(8):191–200. Available from: https://doi.org/10.18502/jfrh.v13i4.2646
Setyorini D, Santoso B, Martini S, et al. Risk factors of preeclampsia and eclampsia in Surabaya. Dama Int J Res 2017;2(7):63–66. Available from: http://repository.unair.ac.id/id/eprint/72421
Liwang F, Bhargah A. Preeclampsia management: different insight from hospital to hospital approach in Indonesia. Indonesia J Biomed Sci 2019;13(1):1. DOI: 10.15562/ijbs.v13i1.170.
Akbar MIA, Sari IM, Ernawati E, et al. Plasma level of umbilical cord hemeoxygenase-1 (HO-1) and neonatal outcome in early onset and late onset severe preeclampsia. Mol Cell Biomed Sci 2019;3(1):54. DOI: 10.21705/mcbs.v3i1.57.
Ghosh SK, Raheja S, Tuli A, et al. Can maternal serum placental growth factor estimation in early second trimester predict the occurrence of early onset preeclampsia and/or early onset intrauterine growth restriction? A prospective cohort study. J Obstet Gynaecol Res 2013;39(5):881–890. DOI: 10.1111/jog.12006.
Atluri S, Manoli NS. Comparative study of maternal and perinatal outcome in early onset and late onset preeclampsia. J Evid Based Med Healthc 2016;4(9):499–504. Available from: https://jebmh.com/latest_articles/95605
Wójtowicz A, Zembala-szczerba M, Babczyk D, et al. Early-and late-onset preeclampsia: a comprehensive cohort study of laboratory and clinical findings according to the New ISHHP criteria. Int J Hypertens 2019;2019. Available from: https://doi.org/10.1155/2019/4108271
Staff AC, Redman CWG. Differences between early onset and late onset preeclampsia. 2018. p. 157–172.
The Apgar Score. American College of Obstetricians and Gynecologist. 2017. p. 644.
Das KK, Majumdar MK, Rajkumari S. To study the risk factors associated with early onset versus late onset preeclampsia and its fetomaternal outcome. Int J Res Rev 2018;5(12):342–348. Available from: https://www.ijrrjournal.com/IJRR_Vol.5_Issue.12_Dec2018/Abstract_IJRR0051.html
Aziz A, Mose JC. The differences of characteristic, management, maternal and perinatal outcomes among early and late onset preeclampsia. Open Access Library J 2016;03(06):1–7. DOI: 10.4236/oalib.1102750.
Pinheiro CC, Rayol P, Gozzani L, et al. The relationship of angiogenic factors to maternal and neonatal manifestations of early-onset and late-onset preeclampsia. Prenat Diagn 2014;34(11):1084–1092. DOI: 10.1002/pd.4432.
Gathiram P, Moodley J. Pre-eclampsia: its pathogenesis and pathophysiolgy. Cardiovasc J Afr 2016;27(2):71–78. DOI: 10.5830/CVJA-2016-009.
Simsek A, Uludag S, Tuten A, et al. Maternal and perinatal outcomes in early onset and late onset preeclampsia. Clin Exp Obstet Gynecol 2018;45(6):837–841. DOI: 10.12891/ceog4212.2018.
Várkonyi T, Nagy B, Füle T, et al. Microarray profiling reveals that placental transcriptomes of early-onset HELLP syndrome and preeclampsia are similar. Placenta 2011;32:S21–S29. DOI: 10.1016/j.placenta.2010.04.014.
Haram K, Mortensen JH, Nagy B. Genetic aspects of preeclampsia and the hellp syndrome. J Pregnancy 2014;2014:910751. DOI: 10.1155/2014/910751.
Schaarschmidt W, Rana S, Stepan H. The course of angiogenic factors in early-vs late-onset preeclampsia and HELLP syndrome. J Perinat Med 2013;41(5):511–516. DOI: 10.1515/jpm-2012-0248.
Kucukgoz Gulec U, Ozgunen FT, Buyukkurt S, et al. Comparison of clinical and laboratory findings in early- and late-onset preeclampsia. J Matern Fetal Neonatal Med 2013;26(12):1228–1233. DOI: 10.3109/14767058.2013.776533.
Bokslag A, Franssen C, Alma LJ, et al. Early-onset preeclampsia predisposes to preclinical diastolic left ventricular dysfunction in the fifth decade of life: an observational study. PLoS One 2018;13(6):1–14. DOI: 10.1371/journal.pone.0198908.
Burton GJ, Redman CW, Roberts JM, et al. Pre-eclampsia: pathophysiology and clinical implications. BMJ 2019;366:1–15. DOI: 10.1136/bmj.l2381.
Ni Y, Cheng W. Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsia. Hypertens Pregnan 2016;35(3):1955. DOI: 10.3109/10641955.2016.1143486.
Madazli R, Yuksel MA, Imamoglu M, et al. Comparison of clinical and perinatal outcomes in early- and late-onset preeclampsia. Arch Gynecol Obstet 2014;290(1):53–57. DOI: 10.1007/s00404-014-3176-x.
Wadhwani P, Saha PK, Kalra JK, et al. A study to compare maternal and perinatal outcome in early vs late onset preeclampsia. Obstet Gynecol Sci 2020;63(3):270–277. DOI: 10.5468/ogs.2020.63.3.270.
Redman CW. Early and late onset preeclampsia: two sides of the same coin. Pregnancy Hypertens 2017;7(2017):58. DOI: 10.1016/j.preghy.2016.10.011.
Haksari EL. Low birthweight and preterm infants in Indonesia. Neo Rev 2019;20(10):548–560. DOI: 10.1542/neo.20-10-e548.
Svenvik M, Brudin L, Blomberg M. Preterm birth: a prominent risk factor for low apgar scores. Biomed Research International. 2015;2015:978079. DOI: 10.1155/2015/978079.
Taha Z, Hassan AA, Wikkeling-Scott L, et al. Factors associated with preterm birth and low birth weight in Abu Dhabi, The United Arab Emirates. Int J Environ Res Public Health 2020;17(4):1382. DOI: 10.3390/ijerph17041382.
Lee HC, Subeh M, Gould JB. Low Apgar score and mortality in extremely preterm neonates born in the United States. Acta Paediatr 2010;99(12):1785–1789. DOI: 10.1111/j.1651-2227.2010.01935.x.