A Study On The Correlation Between Early Onset Preeclampsia And Chorionicity Of Twin Pregnancies

Background and purpose:Hypertensive disorders of pregnancy(HDP)is a common disease in obstetrics where pregnancy and elevated blood pressure coexist.Preeclampsia seriously affects maternal and infant health.In severe cases,it can cause terminal organ damage and even convulsions.At present,it is generally considered that onset at < 34 weeks is called early onset preeclampsia.And multiple pregnancy belongs to high-risk pregnancy,so we should strengthen the management of pregnancy and perinatal period.More and more studies have shown that there may be a certain correlation between the occurrence and development of early onset preeclampsia and the chorionic of twins.In this paper,156 pregnant women with different chorionic early-onset preeclampsia treated in Northwest Women and Children’s Hospital were retrospectively analyzed in terms of gestational weeks,gestational weeks of delivery,perinatal complications and neonatal outcomes,and then to explore its clinical significance.Materials and methods:Retrospective analysis was performed on the clinical data of 156 pregnant women with preeclampsia during the period from January 2016 to December 2019 who were admitted to Northwest Women and Children’s Hospital.They were divided into the monochodonic diamnionic group(33 cases)and the dichorionic diamnionic group(123cases),and the basic data,pregnancy complications,pregnancy outcomes and neonatal outcomes of the two groups were compared.The clinical data of 84 pregnant women with twin pregnancy complicated with late-onset preeclampsia were collected to compare the pregnancy complications and perinatal outcome between early-onset and late-onset preeclampsia.The statistical software SPSS 22.0 was used to analyze the clinical data collected.Results:1.From 2016 to December 2019,156 pregnant women with early onset preeclampsia were divided into MCDA group(n=33)and DCDA group(n=33).There was significant difference between the two groups(p < 0.05).In addition,Late preeclampsia occurred in 84 twin pregnant women,including 13 cases of MCDA and 71 cases of DCDA,there was no significant difference between the two groups.2.Basic situation of MDCA group and DCDA group:In MCDA group,younger age of onset,higher BMI before pregnancy,more weight gain during pregnancy,higher systolic and diastolic blood pressure since onset,longer hospital stay and less assisted reproductive pregnancy were found in MICU group.There were significant differences in onset season and education level between the two groups(p < 0.05).3.Pregnancy complications in MCDA group and DCDA group:The incidence of ICP and GDM was higher in MCDA group,and the difference was statistically significant(p <0.05).Pregnancy complications in patients with early-onset and late-onset preeclampsia:the incidence of anemia and ICP in early-onset group was significantly higher than that in early-onset group(p < 0.05).4.Special complications during pregnancy in MCDA group and DCDA group:The incidence of HELLP syndrome,placenta previa and complicated twins was significantly higher in MCDA group(p < 0.05).Complicated and non-complicated twins in MCDA group: the incidence of IVF-ET,anemia during pregnancy,ICP and GDM was higher in complex group,and the difference was statistically significant(p < 0.05).There was no significant difference in complications between complicated and non-complicated twins in DCDA group.Basic data of complicated twins in MCDA group and DCDA group: the MDCA group had more weight gain during pregnancy,higher BMI before pregnancy,early gestational weeks of onset and delivery,higher diastolic blood pressure since onset,higher incidence of anemia during pregnancy,ICP and GDM,and the difference was statistically significant(p < 0.05).5.Fundus examination and placental pathology in MCDA and DCDA group:there was no significant difference in fundus examination between MCDA group and DCDA group.The incidence of acute chorioamnionitis and placental hematoma was significantly higher in MCDA group(p < 0.05).6.Discharge condition of patients in MCDA group and DCDA group: the diastolic blood pressure in MCDA group was higher on the day of discharge,and the difference was statistically significant(p < 0.05).Discharge of early-onset and late-onset preeclampsia: the systolic blood pressure was higher in the early-onset group on the day of discharge,and the difference was statistically significant(p < 0.05).7.Neonatal outcomes in MCDA group and DCDA group:In the MCDA group,the gestational weeks were early,the body weight of the elder and the children were small,thedays of stay in MICU was longer and the number of newborns were more,and the difference was statistically significant(p<0.05).The incidences of RDS,atrial septal defect,patent ductus arteriosus,NEC and intracranial hemorrhage were significantly higher in MCDA group(p<0.05).The neonatal outcomes of early and late onset preeclampsia: in the early-onset group,the body weight of the two newborns was small,the Apgar score was low at the first minute,the days of stay in MICU was longer and the number of newborns were more,and the incidence of RDS,atrial septal defect,patent foramen ovale,patent ductus arteriosus,NEC,intracranial hemorrhage and retinopathy was significantly higher(p<0.05).Conclusions:1.Early preeclampsia is correlated with twin chorionicity: the probability of early onset preeclampsia in MCDA is significantly higher than that in DCDA.However,there was no significant correlation between chorionicity and late-onset preeclampsia.2.Monochorionic twin pregnancy is a high risk factor for early onset preeclampsia.Patients generally have advanced age,assisted reproductive pregnancy,pre-pregnancy obesity,low education,excessive weight gain during pregnancy,and the gestational and delivery weeks of early-onset preeclampsia are small.Early and many complications,serious illness;poor fetal and neonatal prognosis,easy to cause adverse maternal and fetal outcomes.3.In early onset preeclampsia of monochorionic twin pregnancy,the probability of complicated twins is significantly higher than that of dichorionic twin pregnancy,and the condition is serious and there are many complications.The pregnancy outcome of monochorionic and dichorionic twin pregnancy with complicated twins was worse than that of non-complicated twins.It is suggested by pathological examination that the mechanism of high incidence of preeclampsia in monochodonic twins is not only the problem of vascular remodeling,but also the interaction between vascular anastomosis and inflammatory factors.4.The systolic blood pressure of patients with early onset preeclampsia was high on the day of discharge,and the diastolic blood pressure of monochorionic twin pregnancy was high on the day of discharge,which increased the probability of postpartum hypertension.5.The neonatal outcome of patients with early onset preeclampsia was significantly worse than that of patients with late onset preeclampsia.The neonatal outcome of patients with early-onset preeclampsia was significantly worse than that of patients with late-onsetpreeclampsia.