The frequency and severity of placental findings in women with preeclampsia are gestational age dependent

doi:10.1067/S0002-9378(03)00576-3

American Journal of Obstetrics and Gynecology

Volume 189, Issue 4, October 2003, Pages 1173-1177

https://doi.org/10.1067/S0002-9378(03)00576-3 Get rights and content

Abstract

Objective

The purpose of this study was to evaluate placental lesions found in women with preeclampsia compared with normotensive control subjects and to determine whether the presence of these lesions are related to gestational age at delivery.

Study design

Placental disease of women with preeclampsia at 24 to 42 weeks of gestation was compared with the placental disease of normotensive gestational age–matched control subjects. The placental lesions that were studied specifically included decidual arteriolopathy, thrombi in the fetal circulation, central infarction, intervillous thrombi, and hypermaturity of villi. Data analysis involved the χ² test, the Student t test, and logistic regression; odds ratios and CIs were estimated.

Results

Placentas from women with preeclampsia (n = 158) and normotensive control subjects (n = 156) were evaluated. Among women with preeclampsia, 67% had severe disease. Placental lesions were studied according to gestational age at delivery: <28, 28 to 32, 33 to 36, and ≥37 weeks of gestation. Of the placental lesions that were studied, decidual arteriolopathy (odds ratio, 23.8, 95% CI 10.0-57.0), hypermaturity of villi (odds ratio, 12.4; 95% CI 5.3-29.2), intervillous thrombi (odds ratio, 1.95;95% CI 1.0-3.7), central infarction (odds ratio, 5.9; 95% CI 3.1-11.1), and thrombi in the fetal circulation (odds ratio, 2.8; 95% CI 1.2-6.6) were found to have significantly higher rates in the preeclamptic group. In contrast, the rate of chorioamnionitis was significantly lower in the preeclamptic group (odds ratio, 0.2; 95% CI 0.1-0.4). The rates of abruptio placentae and meconium staining were not different between the two groups. Within the preeclamptic group, the rates of decidual arteriolopathy (P<.0001), central infarction (P = .0001), and hypermaturity of villi (P<.0001) were higher the earlier the gestational age at delivery.

Conclusion

Placentas in women with preeclampsia have increased amounts of disease. The rate is increased with lower gestational ages at the time of delivery for women with preeclampsia.

Section snippets

Material and methods

A case control study of placental disease was performed at the University of Cincinnati Medical Center, with the approval of the Institutional Review Board. Patients who were delivered of singleton pregnancies from July 1, 1994, through December 31, 2000, and who were identified from an established placental disease database were considered eligible. Maternal medical records were reviewed to confirm the diagnosis of preeclampsia and gestational age at the time of delivery. Gestational

Results

We evaluated 158 placentas of women with preeclampsia and 156 placentas of gestational age–matched normotensive control subjects. Maternal age at delivery, parity, race, and mode of delivery are presented in Table I. Women in the study group had a lower mean maternal age, were more likely to be nulliparous, and required operative delivery. Table II shows the gestational ages of the two study groups. In the control group, 104 women were delivered preterm (44% with preterm labor, 29% with preterm

Comment

The findings in this study support the hypothesis that placental lesions are more common in the placentae of women with preeclampsia, particularly at early gestational ages. These pathologic abnormalities could explain the various clinical manifestations in women with severe preeclampsia. For example, in some women with preeclampsia, the disease manifests with maternal factors such as uncontrolled hypertension or eclampsia. In other women, evidence of fetal compromise including intrauterine

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^☆: Presented at the Sixty-Ninth Annual Meeting of the Central Association of Obstetrics and Gynecology, Las Vegas, Nev, October 2002.

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The frequency and severity of placental findings in women with preeclampsia are gestational age dependent☆

Abstract

Objective

Study design

Results

Conclusion

Section snippets

Material and methods

Results

Comment

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Placenta

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Placenta

Prevention of preeclampsia with low-dose aspirin in healthy, nulliparous pregnant women

N Engl J Med