Comparison Between The Clinical Outcomes Of Early Onset Preeclampsia And Late Onset Preeclampsia

BACKGROUND Hypertensive disorders of pregnancy affect about 10% of all pregnant women around the world.This assembly of conditions includes gestational hypertension,pre-eclampsia,and eclampsia along with chronic hypertension.Pre-eclampsia,however,is one of the leading causes of maternal mortality in the world affecting about 2-8% of pregnancy.Severe forms of preeclampsia occurring before 34 weeks of gestation are coined as early-onset preeclampsia and those women suffering after the 34 th week of pregnancy fall under the category of late-onset preeclampsia group.Even though the presenting features overlap,there are differences in maternal and perinatal outcome,prognosis and complications.Early and late onset preeclampsia have different etiologies and should be considered as different disease.Early onset preeclampsia is the most severe clinical variant of disease occurring 5-20% of all cases of preeclampsia and is associated with neonatal morbidity and mortality.Late onset preeclampsia occurring about 75-80% of all cases of preeclampsia;which are associated with maternal morbidity(metabolic syndrome,impaired glucose tolerance,obesity,dyslipidemia,chronic hypertension),normal birth weight and normal placental volume.Studies show the magnitude of feto-maternal outcome owing to early onset preeclampsia is more severe as compared to preeclampsia of late onset.However,the literature available is limited,therefore studies on this topic should be encouraged.OBJECTIVE Early-onset preeclampsia and late-onset preeclampsia have not been studied thoroughly including their risk factors along with maternal and fetal/perinatal health.In this thesis,the effects of EOPE and LOPE on maternal and perinatal outcomes as well as the known risk factors of preeclampsia have been adequately examined.1.Primary objective-To compare the incidence of different maternal and fetal complications in EOPE and LOPE-To know the feto-maternal outcome in EOPE and LOPE 2.Secondary objective-To correlate gestational age at the time of diagnosis with fetal outcome-To correlate maternal complication with fetal outcomeSTUDY DESIGN It is a comparative study conducted at a tertiary hospital in India.A total of 320 singleton pregnancies with preeclampsia were recruited for this retrospective study where one hundred and sixty of those pregnant women who developed preeclampsia before 34 weeks of gestation were enrolled in the Early-onset preeclampsia group and the rest 160 patients with preeclampsia development after 34 weeks of pregnancy were categorized in late-onset preeclampsia group.All study procedures were approved by the Ethics and Human Investigation Committees at AMRI Hospital and were registered.METHODS The study is performed at AMRI Hospitals,Bhubaneswar,India where all the patients who were chosen for the study delivered their offspring between January 2019 to January 2021(n=320).The patients who met the inclusion criteria,were divided in two groupsearly-onset preeclampsia and the other one being,late-onset preeclampsia group.The distinction criterion for early versus late-onset was set as 34 weeks of gestation.Clinical findings and maternal–perinatal outcomes were compared between the groups.Confounding factors such as maternal age,maternal employment during pregnancy,monthly household income,maternal education,her parity,intake of excessive salt in diet and family history of hypertension were adjusted.All the data was collected and stored in SPSS software and analyzed.A p value <0.05 was regarded as statistically significant.RESULTS 1 In our study,there were 160 patients with early-onset severe preeclampsia and 160 had late-onset preeclampsia.Most of them were in the age group of 21 – 30 years,mean maternal age was lower in early-onset preeclampsia(24.41years),whereas late-onset preeclampsia women had a higher mean maternal age of 29.28 years.2 Most of the participants were primigravida(60%).The parity status showed no significant difference(p>0.05)between the EOPE and LOPE.Around 39.4% and 30.6% of participants were multigravidas in EOPE and LOPE respectively.Primigravida women were slightly lower in the EOPE group(60.6%)as compared to the LOPE group(69.4%);the difference was statistically not significant(p=0.101).3 Mean gestational age at diagnosis was 31 weeks in the early-onset group and 35 weeks in the late-onset group.A higher proportion of participants in the EOPE had lower gestational age at birth as compared to the LOPE and the results were statistically significant at 5%.4 The FGR status showed a higher proportion of the participant having FGR in the EOPE group(99.4%)as compared to the LOPE group(40.6%).The difference was found to be statistically significant(p<0.001).5 Most of the participants in the EOPE group showed doppler changes in the form of uterine artery changes in the ultrasound(99.4%)as compared LOPE group(79.4%).The difference was found to be statistically significant(p<0.001).6 The maternal complications and fetal complications were significantly higher in the EOPE group when compared with the LOPE group.The most common maternal complication was anemia followed by thrombocytopenia in both groups.7 The fetal complications showed that proportions of FGR,oligohydramnios,Lower APGAR score,RDS and Prolonged NICU admission was significantly higher in the EOPE group as compared to the LOPE group.CONCLUSION 1.Preeclampsia is a major complication in pregnancy with significant short-term and long-term consequences for both mother and fetus.2.Nulliparity can evidently play a role as a risk factor in both EOPE and LOPE 3.Early onset severe preeclampsia is associated with significant maternal and fetal complications.4.Early registration and regular antenatal visit hold utmost importance in achieving better maternal and fetal outcome.5.Decision regarding termination of pregnancy has to be taken based on both maternal and fetal factors.In case of severe uncontrolled blood pressure with complications,termination should be done irrespective of fetal maturity.6.Good NICU improves the fetal prognosis.The provision of corticosteroids when administered to fetus for lung maturation can reduce complications of perinatal outcomes.7.An ultrasound with doppler study can be beneficial as early doppler changes in uterine artery can be significant and may work as an index of prognosis.