The Contrastive Analysis Of Clinical Characteristics In Early-onset Preeclampsia

Preeclampsia is a heterogeneous human pregnancy-specific syndrome and continues to be a major contributor to maternal and neonatal mortality and morbidity. It has been characterized by some investigators as two different diseases based on gestational age. Early-onset preeclampsia is usually defined as preeclampsia developing before 34 weeks gestation, while late-onset preeclampsia develops at or after 34 weeks gestation. Early- and late-onset preeclampsia are characterized by different pathogenesis patterns and clinical features; they are also associated with different maternal and fetal outcomes. Early-onset preeclampsia accounts for 0.9% of gestational hypertension cases with early onset, rapid progress and severe maternal/neonatal mortality and morbidity. Nowadays, it is still difficult to deal with early-onset preeclampsia. Therefore, further research to early-onset preeclampsia means a lot to obstetrics and maternal/neonatal prognosis. Section I. The pathogenesis features of early-onset preeclampsiaEarly-onset preeclampsia is one special type of gestational hypertension and characterized by different pathogenesis patterns and clinical features between late-onset preeclampsia with severe maternal/neonatal mortality and morbidity. Although the exact cause of early-onset preeclampsia remains unknown, it is widely accepted that the genesis is associated with deficient trophoblast invasion leading to generalized endothelial dysfunction and an exaggerated inflammatory response.Section II. Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsiaObjective To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia(EOP) and late-onset preeclampsia(LOP).Methods In this randomized retrospective study, 200 preeclampsia patients in our hospital were recruited from January 1, 2012 to June 30, 2014. We divided patients into EOP and LOP groups(100 cases each) according to gestational age onset. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between two groups.Results Significant differences were observed between the groups regarding indications for terminating pregnancy. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly lower, latent period for delivery was significantly longer, admission 24 h proteinuria was significantly higher in EOP than LOP group(p<0.05).Conclusion EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery.EOP might be a placental-derived disease complicated by severe placental and perinatal injuries; LOP might be a maternal-injury derived disease condition.Section III. Clinical differences between multiple and singleton pregnancies of early-onset preeclampsiaObjective To analyze the clinical differences between multiple and singleton pregnancies. To discuss the impact of embryo number on the clinical characteristics in early-onset preeclampsia.Methods In this randomized retrospective study, 100 patients with early-onset preeclampsia in our hospital from January 1, 2012 to June 30, 2014 were recruited in the research. We divided the patients into multiple pregnancies group with 21 cases and singleton pregnancy group with 79 cases according to the embryo number. The differences of maternal and perinatal clinical characteristics before and after birth were compared between the two groups.Results The systolic and diastolic pressure at admission were significantly lower in MP group than in SP group(p<0.05). The neonatal birth weight was significantly higher in multiple pregnancies group than in singleton pregnancy group(p<0.05). The incidence rate of abnormal umbilical arteries resistance scores(S/D), abnormal fetal heart rate, low birth-weight infant, neonatal asphyxia, neonatal cardiovascular abnormalities and neonatal infections were significantly lower in multiple pregnancies group than in singleton pregnancy group(p<0.05). The incidence rate of pregnancy edema was significantly higher in multiple pregnancies group than in singleton pregnancy group(p<0.05).Conclusion Early-onset preeclampsia seems to be protective for perinatal infants' survival in multiple pregnancies. The maternal and perinatal infants' clinical findings of multiple pregnancies were superior to singleton pregnancy in early-onset preeclampsia.