EARLY AND LATE PREECLAMPSY: MATERNAL, PERINATAL OUTCOMES AND PATHOMORPHOLOGICAL CHANGES OF THE PLACENTA
Introduction: Preeclampsia (PE) is one of the important causes of maternal and perinatal morbidity and mortality worldwide, with a prevalence of 4–6%. To date, the exact pathogenesis of PE has not been established, but its occurrence is associated with impaired trophoblast invasion, incomplete transformation of the spiral arteries, impaired immune system and an increase in the level of markers of endothelial dysfunction. Recently, more and more researchers believe that, despite the similarity of the diagnostic criteria for PE, the pathogenesis of preeclampsia with early - onset (up to 34 weeks) differs from PE with late - onset (after 34 weeks). Maternal and perinatal morbidity and mortality rates are much higher in early preeclampsia than in late preeclampsia. With early preeclampsia, morphohistological changes in the placenta are more often observed than with late preeclampsia.
Objective: to compare maternal, perinatal outcomes and pathomorphological changes of the placenta in early –onset and late - onset preeclampsia.
Materials and methods: Study design: a cross-sectional retrospective study. We carried out a retrospective analysis of the birth histories of 308 pregnant women with preeclampsia at the Semey Perinatal Center and the accounting and reporting documentation of the Semey Pathological Anatomical Bureau from January 2017 to November 2019.
Statistical analysis was performed using SPSS software (version IBM SPSS Statistics 20). When comparing quantitative features with a normal distribution, we used t - Student's test for unrelated samples, if the distribution differed from normal, we used the U - Mann-Whitney test. When comparing the relative performance between the two groups, depending on the value of the expected event, we used the Pearson test (χ2) with Yates's correction for continuity and Pearson's (χ2). The critical level of significance p when testing statistical hypotheses was taken equal to 0.05.
Results: During the study birth histories with preeclampsia were analyzed: with early -onset PE (up to 34 weeks) - 128 (41.5%), with late -onset PE - 180 (58.5%). Surgical delivery for early preeclampsia was performed in 69 cases (53.9%), with late PE in 34 (18.8%). Perinatal mortality with early PE was 4.7%, with late PE - 1.7%. Placental abruption with early -onset PE was 1.6%, with late - onset PE - 0.5%. When assessing the morphohistological characteristics of these placentas in early PE, more pronounced morphological changes were noted, in the form of a decrease in the size of the placenta in comparison with gestational age, chronic focal abnormalities in the placenta (calcifications and petrification), thinning of the placenta, and a decrease in its weight were revealed.
Conclusions: our study showed that, despite the similarity of clinical and laboratory data for early and late preeclampsia, maternal, perinatal outcomes and pathological changes have statistically significant differences. Further research is needed in this direction, because dividing preeclampsia into subtypes will help to understand the underlying pathophysiology in order to further develop effective prevention and treatment.
Ayaulym N. Nurgaliyeva2, https://orcid.org/0000-0002-7262-1768
Gulnara T. Nurgaliyeva1, https://orcid.org/0000-0002-2161-105X
Madina K. Kadyrgazina2, https://orcid.org/0000-0001-6079-4146
Nargiz Bakytzhankyzy2, https://orcid.org/0000-0003-1344-8675
Alma M. Zhexenayeva2, https://orcid.org/0000-0002-4378-9799
Aruzhan A. Kurabay2, https://orcid.org/0000-0002-2420-9429
Gulshat K. Manabaeva3, https://orcid.org/0000-0002-8217-7680
1 NCJSC "Semey Medical University", Department of Clinic, Semey, Republic of Kazakhstan;
2 NCJSC "Semey Medical University", 5th year student, group 501 of the specialty "General Medicine", Semey, Republic of Kazakhstan;
3 NCJSC "Semey Medical University", Department of Perinatology named after A.A. Kozbagarov, Semey, Republic of Kazakhstan.
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Nurgaliyeva A.N., Nurgaliyeva G.T., Kadyrgazina M.K., Bakytzhankyzy N., Zheksenayeva A.M., Kurabay A.A., Manabaeva G.K. Early and late preeclampsy: maternal, perinatal outcomes and pathomorphological changes of the placenta // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 5, pp. 40-48. doi 10.34689/SH.2021.23.5.005Related publications:
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