The role of placental histopathological lesions in predicting recurrence of preeclampsia†‡. (28th September 2016)

• Record Type: Journal Article
• Authors: Weiner, Eran; Mizrachi, Yossi; Grinstein, Ehud; Feldstein, Ohad; Rymer‐Haskel, Noa; Juravel, Elchanan; Schreiber, Letizia; Bar, Jacob; Kovo, Michal
• Is Part Of: Prenatal diagnosis. Volume 36:Number 10(2016)
• Page Start: 953
• Page End: 960
• Publication Date: 2016-09-28
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.4918
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract : What's Already Known About This Topic? Pregnant women with a history of preeclampsia are at increased risk for recurrence. Various maternal underlying risk factors have been suggested as predictors of recurrence of preeclampsia. Prediction models for recurrence of preeclampsia are mostly based on first trimester maternal biochemical markers alongside with demographics and biophysical characteristics. Preeclampsia is associated with increased rate of placental maternal vascular malperfusion histopathological lesions. What Does This Study Add? Placental maternal and fetal vascular malperfusion lesions, in pregnancies complicated with preeclampsia, are independently associated with recurrence of preeclampsia in subsequent pregnancy. A clinical–pathological prediction model for recurrence of preeclampsia is superior to a prediction model based on clinical factors only. Abstract: Objective: We aimed to study the role of placental pathology in the prediction of preeclampsia (PE) recurrence. Methods: The medical records and pathological placental reports of all women diagnosed with PE, during 2008–2015, were reviewed. The study population was divided according to the outcome of their subsequent pregnancy: those who did (recurrence group) or did not (no‐recurrence group) develop recurrent PE. Data regarding maternal characteristics and placental maternal/fetal vascular malperfusion lesions, of the initial pregnancies, were compared. Two prediction models were generated for PE recurrence. Results: Compared to the no‐recurrence group ( n = 130), the recurrence group ( n = 96) was characterized by lower gestational age ( p < 0.001), longer inter‐pregnancy interval ( p = 0.012), and higher rate of severe features ( p < 0.001). By logistic regression analysis composite maternal (aOR = 3.05, 95%CI 1.39–6.71, p = 0.005), fetal (aOR = 9.31, 95%CI 3.9–22.1, p < 0.001), and concurrent maternal + fetal (aOR = 13.94, 95%CI 5.08–38.21, p < 0.001), vascular malperfusion lesions were found to be independently associated with recurrence. A clinical prediction model accounted for 20.8% of PE recurrence ( R 2 = 0.208, AUC = 0.732), while a clinical–pathological model accounted for 34.2% of recurrence ( R 2 = 0.342, AUC = 0.80). Conclusion: Placental maternal and fetal vascular malperfusion lesions are independently associated with increased risk for PE recurrence. A clinical–pathological prediction model for recurrence of PE is superior to a prediction model based merely on clinical factors. © 2016 John Wiley & Sons, Ltd.