Sreedevi Atluri 1 , Nandish S. Manoli
BACKGROUND Preeclampsia is the leading cause of maternal and perinatal morbidity and mortality worldwide, the exact aetiology of which is still unknown. The concept of early and late pre-eclampsia depending on gestational age at onset is more modern and is widely accepted that these two entities have different aetiologies and should be considered as different forms of the disease. Even though the presenting features overlap, these two entities of preeclampsia differ by biochemical markers, maternal and foetal outcomes. Aim of the Study- This study compares early-onset preeclampsia and late-onset preeclampsia with respect to their clinical presentation, laboratory parameters, management options, maternal and foetal outcomes which gives us an idea that these two preeclampsia subtypes have different pathological processes and a need for varied clinical approach to prevent adverse outcomes. METHODS This is a prospective comparative study conducted in JSS Hospital, Mysore from November, 2014 to June, 2016. All Antenatal cases (both booked and unbooked) with gestational age ≥20 weeks between 18 yrs. and 40 yrs. of age diagnosed as preeclampsia as per the inclusion and exclusion criteria attending the outpatient department or admitted were selected and divided in to two groups, early onset preeclampsia (EOP) group if gestational age at onset of preeclampsia is before 34 weeks and late onset preeclampsia if gestational age at onset is at 34 weeks or later were observed until delivery and early postpartum period and babies till early neonatal period. RESULTS A total of 158 patients at >20 weeks of gestation with preeclampsia were enrolled for this study. Early-onset Preeclampsia (EOP) and Late-onset Preeclampsia (LOP) had 75 and 83 pre eclamptic women respectively. Early onset group had severe clinical picture with deranged laboratory findings (Thrombocytopenia, altered liver enzymes, lactic dehydrogenase (LDH) levels, urea and creatinine levels) compared to late onset group (p<0.001). High BMI values were noticed in late onset preeclampsia (LOP) group compared to early onset preeclampsia (EOP) (p<0.001). The maternal HELLP syndrome incidence, usage of number of anti-hypertensives, MgSO4 therapy, length of intensive care unit (ICU) and hospital stay were statistically significant in early onset preeclampsia (EOP) group. The incidences of intrauterine growth retardation (IUGR), oligohydramnios, abnormal uterine artery Doppler were significantly different between the groups. Low Apgar score at 5th min, increased requirement for neonatal intensive care unit (NICU) stay, still births and perinatal mortality were significantly higher in early onset preeclampsia (EOP) group. CONCLUSION This study confirms that early onset preeclampsia is more severe entity with adverse maternal and perinatal outcomes compared to late onset. The implication of these findings might lead to understanding of different pathophysiological mechanisms underlying these entities and the need for prevention, follow-up and early treatment to prevent adverse outcomes of preeclampsia.
