Maternal-perinatal outcome in pregnancies complicated by preeclampsia: Looking at early and late onset disorders

Abstract

Background: Globally, preeclampsia; an idiopathic pregnancy-related proteinuric hypertensive disorder remains one of the major causes of maternal and perinatal morbidity and mortality, worst so in low resources settings. Accumulating evidence indicates that the outcome is influenced by the gestational age at onset of the disorder. Aim: We investigated the perinatal and maternal outcomes of pregnancies complicated by preeclampsia and in addition compared the early onset and late onset types. Materials and Methods: An analytical observational study was carried on all cases of preeclampsia managed in tertiary hospital between 2013 and 2019. The participants were comparatively studied for maternal and perinatal outcomes. Results: The incidence of preeclampsia was 7.1%. About a third 31.9% were early onset and 68.1% late onset disease. Maternal complications were frequent in preeclampsia; 24.5% eclampsia, an incidence of eclampsia of 56/3474 (1.61%), 74.2% cesarean section, 23.6% severe proteinuria, 12.2% anemia, 11.4% postpartum hemorrhage, 3.1% pulmonary edema, 1.7% thrombocytopenia, 0.9% hemolysis, elevated liver enzymes and low platelet syndrome and acute renal failure, respectively. These were more frequent in late preeclampsia but severer in early onset disease. Case fatality rate was 1.75% and maternal mortality ratio 117.7/100,000 live births. Mean gestational age at delivery in preeclampsia was 35.4 weeks with 51% preterm births and 28.8% small for gestational age neonates with early onset disease contributing more than twofold. The perinatal mortality was high at 21.4%; a perinatal mortality rate of 14.2/1000 total births with 6-fold among early onset disease mostly from iatrogenic prematurity. Conclusions: The incidence of preeclampsia was high, maternal morbidity though more common among late onset disease, was severer among the early onset disease which also had worse adverse perinatal outcomes.

Keywords

• early onset
• late onset
• maternal
• morbidity
• mortality
• nigeria
• outcomes
• perinatal
• preeclampsia