Fetal growth restriction as a diagnostic criterion for preeclampsia.

OBJECTIVES: Currently, no unified set of criteria to classify preeclampsia (PE) exists. Further, no consensus has been reached whether fetal growth restriction (FGR) should be included in diagnostic criteria for PE. We examined the adequacy of including FGR in diagnostic criteria for PE. STUDY DESIGN: Singleton pregnancy patients who developed PE before 34 weeks of gestation managed at a tertiary center between 2010 and 2016 were included. Patients were divided into two groups according to cause for PE diagnosis. In addition, those diagnosed with PE because of gestational hypertension (GH) and FGR were divided into two groups according to presence of proteinuria or organ dysfunction during the expectant management. MAIN OUTCOME MEASURES: Pregnancy prolongation from PE diagnosis. RESULTS: Of 69 PE patients, 18 (28.1%) were diagnosed as PE with GH and only FGR (F group). Pregnancy prolongation between PE diagnosis to delivery was longer in the F group than in PE cases with primary organ dysfunction (P group) (21 vs 10 days, P = 0.049). Of 18 patients in the F group, 12 (66.7%) subsequently had proteinuria or organ dysfunction (S group). The remaining 6 patients (33.3%) had no subsequent proteinuria or organ dysfunction (N group). There were no significant differences in prolongation of pregnancy from organ dysfunction onset to delivery between the S and P groups (10 vs 10 days, P = 0.36). CONCLUSIONS: Organ dysfunction onset may reflect PE progression more accurately than FGR onset. Further investigations on whether to include FGR into the diagnostic criteria for PE are needed.

Does pre-eclampsia without proteinuria lead to different pregnancy outcomes than pre-eclampsia with proteinuria?

AIMS: The Japanese Society for the Study of Hypertension in Pregnancy revised the diagnostic criteria for pre-eclampsia (PE) to conform to those of the International Society for the Study of Hypertension in Pregnancy (ISSHP) in 2018. This study aimed to investigate whether pregnancy outcomes differ based on the presence of proteinuria and validate the adoption of the ISSHP criteria in Japan. METHODS: This is a retrospective study involving 308 women diagnosed with hypertensive disorders of pregnancy at a tertiary center. They were divided into the following groups: PE with proteinuria (n = 218), PE without proteinuria (n = 45) and gestational hypertension (n = 45) according to the ISSHP criteria for comparison of pregnancy outcomes. RESULTS: Applying the ISSHP criteria increased the number of pregnant women diagnosed as having PE by 14.6% (45 women). The difference in the rate of composite maternal complications between the two groups was unremarkable, with 33 cases (15.1%) in the PE with proteinuria group and 9 cases (20%) in the PE without proteinuria group. Moreover, composite neonatal complications occurred in 37 cases (17%) of PE with proteinuria group and 6 cases (13.3%) of PE without proteinuria group, showing remarkably similar incidence rate in the two groups. Women with PE with and without proteinuria had significantly earlier deliveries and lower neonatal birth weight than those with gestational hypertension. CONCLUSION: Pregnancy outcomes of PE with and without proteinuria were almost similar although their incidence increased, confirming its validity for adaptation of the ISSHP criteria in Japan.

Efficacy of expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension before 34 weeks gestation.

OBJECTIVES: To investigate the effect of chronic hypertension on expectant management for preeclampsia (PE). STUDY DESIGN: Pregnant women who were diagnosed with severe PE before 34 weeks of gestation between 2005 and 2016 and managed at a tertiary center were the subjects of the study. Mothers were classified into two groups: a severe superimposed PE (SSP) group and a severe PE (SP) group. We compared the groups in terms of perinatal outcomes. MAIN OUTCOME MEASURES: Pregnancy prolongation from the diagnosis of severe PE to delivery. RESULTS: The SSP group included 30 women whereas the SP group included 79 women. Expectant management could be performed in 24 subjects (80.0%) in the SSP group and 49 (62.0%) in the SP group (P = 0.110). Gestational age at diagnosis of PE (P = 0.016) and gestational age at delivery (P = 0.031) were significantly lower in the SSP group than in the SP group. There were no significant differences between the groups in terms of pregnancy prolongation (SSP, 8.5 days versus SP, 6.0 days; P = 0.25) or maternal and neonatal complications. CONCLUSIONS: Compared to severe PE, severe PE superimposed on chronic hypertension does not increase the prevalence of maternal complications, and an equivalent pregnancy prolongation was obtained. Expectant management was possible in severe superimposed PE on chronic hypertension, as it was in severe PE.