Department of Obstetrics and Gynecology, School of Medicine, Mekelle University, Mek'ele, Ethiopia.
Ayder Comprehensive Specialized Hospital, Quality Assurance Office, Mekelle University, Mek'ele, Ethiopia.
PLoS One. 2023 Feb 27;18(2):e0281952. doi: 10.1371/journal.pone.0281952. eCollection 2023.
Pre-eclampsia-eclampsia syndrome remains the leading cause of maternal and neonatal mortality worldwide. Both from pathophysiologic and clinical stand points, early and late onset preeclampsia are thought to be two different disease entities. However, the magnitude of preeclampsia-eclampsia and maternal-fetal and neonatal outcomes of early and late onset preeclampsia are not adequately investigated in resource-limited settings. This study sought to examine the clinical presentation and maternal-fetal and neonatal outcome of these two entities of the disease in Ayder comprehensive specialized hospital, an academic setting in Tigray, Ethiopia, from January 1, 2015-December 31, 2021.
A retrospective cohort design was employed. The patient charts were reviewed to see the baseline characteristics and their progress from the onset of the disease in the antepartum, intrapartum and postpartum periods. Women who developed pre-eclampsia before 34 weeks of gestation were defined as having early-onset pre-eclampsia, and those who developed at 34 weeks or later were identified as late-onset preeclampsia. We used chi-square, t-test and multivariable logistic regression analyses to determine differences between early- and late onset diseases in terms of clinical presentation, maternal-fetal, and neonatal outcomes.
Among the 27,350 mothers who gave birth at the Ayder comprehensive specialized hospital, 1095 mothers had preeclampsia-eclampsia syndrome, with a prevalence of 4.0% (95% CI: 3.8, 4.2)]. Of the 934 mothers analyzed early and late onset diseases accounted for 253 (27.1%) and 681 (72.9%) respectively. Overall, death of 25 mothers was recorded. Women with early onset disease had significant unfavorable maternal outcomes including having preeclampsia with severity features (AOR = 2.92, 95% CI: 1.92, 4.45), liver dysfunction (AOR = 1.75, 95% CI: 1.04, 2.95), uncontrolled diastolic blood pressure (AOR = 1.71, 95% CI: 1.03, 2.84), and prolonged hospitalization (AOR = 4.70, 95% CI: 2.15, 10.28). Similarly, they also had increased unfavorable perinatal outcomes, including the APGAR score at the 5th minute (AOR = 13.79, 95% CI: 1.16, 163.78), low birth weight (AOR = 10.14, 95% CI 4.29, 23.91), and neonatal death (AOR = 6.82, 95% CI: 1.89, 24.58).
The present study highlights the clinical differences between early versus late onset preeclampsia. Women with early-onset disease are at increased levels of unfavorable maternal outcomes. Perinatal morbidity and mortality were also increased significantly in women with early onset disease. Therefore, gestational age at the onset of the disease should be taken as an important indicator of the severity of the disease with unfavorable maternal, fetal, and neonatal outcomes.
子痫前期-子痫综合征仍然是全球孕产妇和新生儿死亡的主要原因。从病理生理和临床角度来看，早发型和晚发型子痫前期被认为是两种不同的疾病实体。然而，在资源有限的环境中，子痫前期-子痫和早发型和晚发型子痫前期的孕产妇-胎儿和新生儿结局的子痫前期-子痫的严重程度尚未得到充分研究。本研究旨在检查埃塞俄比亚提格雷地区 Ayder 综合专科医院从 2015 年 1 月 1 日至 2021 年 12 月 31 日这两种疾病的临床表现以及孕产妇-胎儿和新生儿结局。
采用回顾性队列设计。回顾患者病历，了解疾病在产前、产时和产后期间的基线特征及其进展。将在 34 周前发生子痫前期的妇女定义为早发型子痫前期，将在 34 周或之后发生子痫前期的妇女定义为晚发型子痫前期。我们使用卡方检验、t 检验和多变量逻辑回归分析来确定早发型和晚发型疾病在临床表现、孕产妇-胎儿和新生儿结局方面的差异。
在 Ayder 综合专科医院分娩的 27350 名母亲中，有 1095 名母亲患有子痫前期-子痫综合征，患病率为 4.0%（95%CI：3.8，4.2）。在分析的 934 名母亲中，早发型和晚发型疾病分别占 253 名（27.1%）和 681 名（72.9%）。总的来说，有 25 名母亲死亡。早发型疾病的妇女有显著不良的孕产妇结局，包括有严重特征的子痫前期（OR = 2.92，95%CI：1.92，4.45）、肝功能障碍（OR = 1.75，95%CI：1.04，2.95）、未控制的舒张期血压（OR = 1.71，95%CI：1.03，2.84）和延长住院时间（OR = 4.70，95%CI：2.15，10.28）。同样，她们也有增加不良围产儿结局，包括第 5 分钟的 APGAR 评分（OR = 13.79，95%CI：1.16，163.78）、低出生体重（OR = 10.14，95%CI 4.29，23.91）和新生儿死亡（OR = 6.82，95%CI：1.89，24.58）。
本研究强调了早发型与晚发型子痫前期之间的临床差异。早发型疾病的妇女有更高水平的不良孕产妇结局。早发型疾病的妇女围产期发病率和死亡率也显著增加。因此，疾病发病时的孕龄应作为疾病严重程度的重要指标，与不良孕产妇、胎儿和新生儿结局相关。
