Clinical and Histopathological Findings in Placentas of Patients with Early- and Late-onset Preeclampsia

Objectives: To describe the clinical and placental histopathological findings in a cohort of patients with early- and late-onset preeclampsia.
Methods: Clinical information of patients diagnosed with preeclampsia (PE) at the Department of Obstetrics, Hospital Universitario San Ignacio, Bogotá, Colombia, between July 2017 and November 2018 were collected. PE was defined according to the Task Force on Hypertension in pregnancy (2013). Early-onset PE (EOP) was defined as diagnosed with preeclampsia before 34 weeks of gestation, and late-onset PE (LOP) was defined as diagnosed after 34 weeks of gestation. The following data were collected: age, primipaternity, parity, body mass index (BMI kg/m2), severity, chronic hypertension, IUGR, history of previous PE, gestational age at delivery, birth weight, baby`s sex, perinatal death and uterine artery (UtA) Doppler velocimetry. Placental pathology examinations were performed in placental tissue using our standard protocol, by a single pathologist.
Results: 216 pregnant women were assessed, 87 (40%) had EOP and 129 (60%) had LOP. The EOP group had a lower median gestational age at delivery (p < 0.0001), lower median birth weight (p < 0.001), chronic arterial hypertension (p = 0.001), severe features (p = <0.001) and altered UtA pulsatility index (p = 0.035). For histopathological analysis 186 placenta swere evaluated, 84 of corresponding to EOP and 102 to LOP. The EOP group had lower placental weight (p < 0.0001), higher placental/baby weight ratio (p < 0.0001) and abnormal umbilical cord insertion (p = 0.027).
Conclusion: In conclusion, EOP is associated with more frequent adverse neonatal outcomes and severity features of PE, altered UtA pulsatility index and lower placental weight but higher placental/baby weight ratio. It is noticeable the greatest frequency of alterations in cord insertion in the LOP, which have not been reported before in placentas with preeclampsia.