Specifics of Pregnancy in Patients with Hypertensive Disorders
Study Objective: comparative analysis of pregnancy progress and outcome in patients with various hypertensive disorders.
Study Design: open prospective study.
Materials and Methods: the study included 165 pregnant women (mean age: 31.72 ± 3.47 years), divided into 6 groups: Sub-group IА — patients with early moderate preeclampsia (PE); sub-group IВ — patients with early severe PE; sub-group IIА — patients with late moderate PE; sub-group IIВ — patients with late severe PE; group III — patients with gestational arterial hypertension (GAH); group IV — patients with chronic arterial hypertension (CAH); group V — CAH-associated PE, group VI (controls) — uncomplicated pregnancy. The women underwent clinical, laboratory and instrumental examination.
Study Results: patients with early severe PE were statistically significantly older than patients with late moderate PE and controls. Body mass index of women with CAH, GAH and CAH-associated PE was higher than that in controls. Differences in family and obstetric history of pregnant women with various hypertensive disorders, which are an unfavourable background affecting the course of pregnancy, were identified.
The manifestation of PE symptoms and complications in trimester II was statistically higher in patients with early severe PE. Foetal growth retardation syndrome (FGRS) was diagnosed only in case of severe PE and CAH-associated PE (15%), HELLP syndrome was recoded in patients with severe PE.
Children with FGRS were more frequently born in the sub-group of early severe PE (ESPE); the rate of complications in early neonatal period in the groups of early PE and CAH-associated PE is quite high. Early neonatal death was recorded in ESPE and CAH-associated PE groups.
Conclusion: when assessing clinical and history risk factors, while focusing on previous PE, it is advisable to take a group of women for thorough monitoring from the very early stage of pregnancy, in order to prevent failures (miscarriage, hypertensive complications, foetal growth retardation syndrome). Taking into account that early and late severe PE as well as CAH-associated PE are the most severe hypertensive disorders in pregnant women, it is recommended to refer such pregnant women to group 3 treatment and prevention institutions.
K.T. Muminova — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 2893-9966. ORCID: http:// orcid.org/0000-0003-2708-4366. E-mail: email@example.com
Z.S. Khodzhaeva — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 9714-5970. ORCID: http:// orcid.org/0000-0001-8159-3714. E-mail: firstname.lastname@example.org
R.G. Shmakov — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynaecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin St., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 3804-3269. ORCID: http:// orcid.org/0000-0002-2206-1002. E-mail: email@example.com
Contribution: Muminova K.T. — patient selection and examination, article preparation, thematic publications reviewing; Khodzhaeva Z.S. — patient selection and examination, data processing analysis and interpretation, article preparation; Shmakov R.G. — review of critically important material, approval of the manuscript for publication.
The authors declare that they do not have any conflict of interests.
- Brown M.A., Magee L.A., Kenny L.C., Karumanchi S.A., McCarthy F.P., Saito S. et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018; 72(1): 24–43. DOI: 10.1161/HYPERTENSIONAHA.117.10803
- Khan K.S., Wojdyla D., Say L., Gülmezoglu A.M., Van Look P.F. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006; 367(9516): 1066–74. DOI: 10.1016/S0140-6736(06)68397-9
- Kuklina E.V., Ayala C., Callaghan W.M. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet. Gynecol. 2009; 113(6): 1299–306. DOI: 10.1097/AOG.0b013e3181a45b25
- Raymond D., Peterson E. A critical review of early-onset and late-onset preeclampsia. Obstet. Gynecol. Surv. 2011; 66(8): 497–506. DOI: 10.1097/OGX.0b013e3182331028
- Stubert J., Ullmann S., Dieterich M. Diedrich D., Reimer T. Clinical differences between early- and late-onset severe preeclampsia and analysis of predictors for perinatal outcome. J. Perinat. Med. 2014; 42(5): 617–27. DOI: 10.1515/jpm-2013-0285
- Ходжаева З.С., Холин А.М., Вихляева Е.М. Ранняя и поздняя преэклампсия: парадигмы патобиологии и клиническая практика. Акушерство и гинекология. 2013; 10: 4–11. [Khodzhaeva Z.S., Kholin A.M., Vikhlyaeva E.M. Rannyaya i pozdnyaya preeklampsiya: paradigmy patobiologii i klinicheskaya praktika. Akusherstvo i ginekologiya. 2013; 10: 4–11. (in Russian)]
- Kucukgoz Gulec U., Ozgunen F.T., Buyukkurt S., Guzel A.B., Urunsak I.F., Demir S.C. et al. Comparison of clinical and laboratory findings in early- and late-onset preeclampsia. J. Matern. Fetal Neonat. Med. 2013; 26(12): 1228–33. DOI: 10.3109/14767058.2013.776533
- Tranquilli A.L., Brown M.A., Zeeman G.G. Dekker G., Sibai B.M. The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Pregnancy Hypertens. 2013; 3(1): 44–7. DOI: 10.1016/j.preghy.2012.11.001
- Khodzhaeva Z.S., Kogan Y.A., Shmakov R.G., Klimenchenko N.I., Akatyeva A.S., Vavina O.V. et al. Clinical and pathogenetic features of early- and late-onset pre-eclampsia. J. Matern. Fetal Neonat. Med. 2016; 29(18): 2980–6. DOI: 10.3109/14767058.2015.1111332
- Parra-Cordero M., Rodrigo R., Barja P., Bosco C., Rencoret G., Sepúlveda-Martinez A. et al. Prediction of early and late pre-eclampsia from maternal characteristics, uterine artery Doppler and markers of vasculogenesis during first trimester of pregnancy. Ultrasound Obstet. Gynecol. 2013; 41(5): 538–44. DOI: 10.1002/uog.12264
- Cheng Y.W., Kaimal A.J., Bruckner T.A. Halloran D.R., Caughey A.B. Perinatal morbidity associated with late preterm deliveries compared with deliveries between 37 and 40 weeks of gestation. BJOG. 2011; 118(2): 1446–54. DOI: 10.1111/j.1471-0528.2011.03045.x
- Lisonkova S., Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am. J. Obstet. Gynecol. 2013; 209(6): 544.e1–12. DOI: 10.1016/j.ajog.2013.08.019
- Адамян Л.В., Серов В.Н., Филиппов О.С., Ходжаева З.С., Башмакова Н.В., Белокриницкая Т.Е. и др. Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. Клинические рекомендации (протокол лечения). В кн.: Анестезия, интенсивная терапия и реанимация в акушерстве и гинекологии. Клинические рекомендации. Протоколы лечения. М.: Медицина; 2018: 372–440. [Adamyan L.V., Serov V.N., Filippov O.S., Khodzhaeva Z.S., Bashmakova N.V., Belokrinitskaya T.E. i dr. Gipertenzivnye rasstroistva vo vremya beremennosti, v rodakh i poslerodovom periode. Preeklampsiya. Eklampsiya. Klinicheskie rekomendatsii (protokol lecheniya). V kn.: Anesteziya, intensivnaya terapiya i reanimatsiya v akusherstve i ginekologii. Klinicheskie rekomendatsii. Protokoly lecheniya. M.: Meditsina; 2018: 372–440. (in Russian)]
- Bartsch E., Medcalf K.E., Park A.L., Ray J.G.; High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016; 353: i1753. DOI: 10.1136/bmj.i1753
- Kattah A., Milic N., White W., Garovic V. Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia. Am. J. Physiol. Regul. Integr. Comp. Physiol. 2017; 313(4): 418–24. DOI: 10.1152/ajpregu.00508.2016
- Dong X., Gou W., Li C., Wu M., Han Z., Li X. et al. Proteinuria in preeclampsia: not essential to diagnosis but related to disease severity and fetal outcomes. Pregnancy Hypertens. 2017; 8: 60–4. DOI: 10.1016/j.preghy.2017.03.005
- Hypertension in pregnancy, developed by the Task Force on Hypertension in Pregnancy. American College of Obstetricians and Gynecologists; 2014. 100 p.
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