Late first-trimester placental disruption and subsequent gestational hypertension/preeclampsia
| Autor: | Joe Leigh Simpson, Elizabeth Thom, Karen Filkins, Julia Zachary, Richard K. Silver, Douglas W. Hershey, Eugene Pergament, Lawrence D. Platt, Ronald J. Wapner, John Philip, Laird G. Jackson, Patrick Mohide, R. Douglas Wilson, Maurice J. Mahoney, Anthony Johnson |
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| Rok vydání: | 2005 |
| Předmět: |
Gestational hypertension
medicine.medical_specialty Preeclampsia Pre-Eclampsia Pregnancy Placenta medicine Maternal hypertension Humans Gynecology Fetus medicine.diagnostic_test business.industry Obstetrics Obstetrics and Gynecology Hypertension Pregnancy-Induced medicine.disease Pregnancy Trimester First medicine.anatomical_structure Chorionic Villi Sampling Needles Cohort Amniocentesis Female business Body mass index |
| Zdroj: | Obstetrics and gynecology. 105(3) |
| ISSN: | 0029-7844 |
| Popis: | OBJECTIVE: To evaluate the potential relationship between placental disruption in weeks 13 and 14 and the subsequent development of gestational hypertension or preeclampsia. METHODS: Using subjects recruited during a randomized trial funded by the National Institute of Child Health and Human Development, which compared early amniocentesis and late transabdominal chorionic villas sampling (CVS) in weeks 13 and 14, rates of gestational hypertension and preeclampsia were compared between cases with varying degrees of placental disruption. RESULTS: A total of 3,698 of 3,775 randomized subjects had cytogenetically normal pregnancies and were analyzed. A significantly higher rate of hypertension/preedampsia was observed in the late CVS group (5.4%, n = 1,878) compared with the early amniocentesis cohort (3.5%, n = 1,820; P = .005). This difference persisted after controlling for maternal age, body mass index, parity, previous preterm delivery, smoking, and fetal gender. Early amniocentesis cases were further stratified on the basis of whether the placenta had been penetrated (n = 460) or not (n = 1,360). Risk of hypertensive complications was lowest if the placenta was not traversed (3.4%), greater with placental penetration (3.9%), and highest when the placenta was directly sampled during CVS (5.4%, P = .02). CONCLUSION: We hypothesize that focal disruption of the placenta at 13-14 weeks may increase the risk of hypertension/preeclampsia. These findings provide support for the theory that disturbances in early placentation lead subsequently to maternal hypertension. |
| Databáze: | OpenAIRE |
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