Obstet Gynecol Sci.  2016 Nov;59(6):434-443. 10.5468/ogs.2016.59.6.434.

Differences in clinical presentation and pregnancy outcomes in antepartum preeclampsia and new-onset postpartum preeclampsia: Are these the same disorder?

• Vilchez G
• Hoyos LR
• Leon-Peters J
• Lagos M
• Argoti P

• KMID: 2378567
• DOI: http://doi.org/10.5468/ogs.2016.59.6.434

Abstract

OBJECTIVE
New-onset postpartum preeclampsia is a poorly defined condition that accounts for a significant percentage of eclampsia cases. It is unclear whether new-onset postpartum preeclampsia is a different disorder from or belongs to the same spectrum of classic antepartum preeclampsia. The objective of this study was to compare the clinical presentation and pregnancy outcomes of antepartum preeclampsia and new-onset postpartum preeclampsia.
METHODS
A retrospective study including 92 patients with antepartum preeclampsia and 92 patients with new-onset postpartum preeclampsia was performed. Clinical presentation and pregnancy outcomes were compared. Chi-square test was used to analyze categorical variables, and independent t-test and Mann-Whitney U-test for numerical variables. P-values of <0.05 were used to indicate statistical signifi cance.
RESULTS
Patients with antepartum preeclampsia and new-onset postpartum preeclampsia differ significantly in profile, symptoms at presentation, laboratory markers and pregnancy outcomes.
CONCLUSION
New-onset postpartum preeclampsia has a distinct patient profile and clinical presentation than antepartum preeclampsia, suggesting they may represent different disorders. Characterization of a patient profile with increased risk of developing this condition will help clinicians to identify patients at risk and provide early and targeted interventions to decrease the morbidity associated with this condition.

Keyword

Postnatal care; Preeclampsia; Pregnancy-induced hypertension; Pregnancy outcome

MeSH Terms

Biomarkers
Eclampsia
Female
Humans
Hypertension, Pregnancy-Induced
Postnatal Care
Postpartum Period*
Pre-Eclampsia*
Pregnancy
Pregnancy Outcome*
Pregnancy*
Retrospective Studies
Biomarkers

Figure

• 

  Fig. 1 Fluxogram for selection of cases with antepartum and postpartum preeclampsia (n=1,059). Selection of cases with antepartum preeclampsia and new-onset postpartum preeclampsia matched by gestational age and body mass index. The propensity score matching model resulted in 184 matched cases, with 92 in each group.

• 

  Fig. 2 Laboratory markers in cases with antepartum and postpartum preeclampsia (n=184). (A) Biochemical markers and (B) hematologic markers. Significant biochemical and hematologic early in pregnancy and at presentation in cases with antepartum preeclampsia and postpartum preeclampsia. Antepartum preeclampsia in black continuous lines, postpartum preeclampsia in black dashed lines. The dots represents the means, the horizontal lines the trend along pregnancy duration, and the vertical lines the confidence intervals of the means. Changes along pregnancy seem to be more evident in postpartum preeclampsia.

• 

  Fig. 3 Clinical presentation of cases with antepartum preeclampsia and postpartum preeclampsia (n=184). Relative risks of significant clinical symptoms and signs in antepartum preeclampsia and postpartum preeclampsia. The black dots represent the relative risks, the black lines the trend along pregnancy duration, the vertical lines the confidence intervals of the means. Overall postpartum preeclampsia presents higher relative risks of symptoms/signs at presentation.

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