Abstract:
BACKGROUND:The diagnostic criteria for preeclampsia have evolved from the traditional definition of de novo hypertension and proteinuria to a broader definition of hypertension with evidence of end-organ dysfunction. Although this change is endorsed by various societies such as the International Society for the Study of Hypertension in Pregnancy and the American College of Obstetricians and Gynecologists, there remains controversy with regard to the implementation of broader definitions and the most appropriate definition of end-organ dysfunction. OBJECTIVE:This study aimed to assess the impact of different diagnostic criteria for preeclampsia on rates of disease diagnosis, disease severity, and adverse outcomes and to identify associations between each component of the different diagnostic criteria and adverse pregnancy outcomes. STUDY DESIGN:We performed a retrospective cohort study of singleton pregnancies at Monash Health between January 1, 2016 and July 31, 2018. Within this population, all cases of gestational hypertension and preeclampsia were reclassified according to the International Society for the Study of Hypertension in Pregnancy 2001, American College of Obstetricians and Gynecologists 2018, and International Society for the Study of Hypertension in Pregnancy 2018 criteria. Differences in incidence of preeclampsia and maternal and perinatal outcomes were compared between the International Society for the Study of Hypertension in Pregnancy 2001 group and the extra cases identified by American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018. Outcomes assessed included biochemical markers of preeclampsia, a composite of adverse maternal outcomes, and a composite of adverse perinatal outcomes. Multiple logistic regression analysis was also performed to assess each component of the American College of Obstetricians and Gynecologists 2018 and International Society for the Study of Hypertension in Pregnancy 2018 criteria and their associations with adverse maternal and perinatal outcomes. RESULTS:Of 22,094 pregnancies, 751 (3.4%) women had preeclampsia as defined by any of the 3 criteria. Compared with International Society for the Study of Hypertension in Pregnancy 2001, the American College of Obstetricians and Gynecologists 2018 criteria identified an extra 42 women (n=654 vs n=696, 6.4% relative increase) with preeclampsia, and International Society for the Study of Hypertension in Pregnancy 2018 identified an extra 97 women (n=654 vs n=751, 14.8% relative increase). The additional women identified by International Society for the Study of Hypertension in Pregnancy 2018 exhibited a milder form of disease with lower rates of severe hypertension (62.4% vs 44.3%; P<.01) and magnesium sulfate use (11.9% vs 4.1%; P<.05) and a trend toward lower rates of adverse maternal outcomes (9.8% vs 4.1%). These women also delivered at a later gestation, and their babies had a lower number of neonatal intensive care unit admissions and adverse perinatal outcomes. Objective features such as fetal growth restriction, thrombocytopenia, renal and liver impairment, and proteinuria were associated with an increased risk of adverse maternal and perinatal outcomes, whereas subjective neurologic features demonstrated poorer associations. CONCLUSION:Implementation of broader definitions of preeclampsia will result in an increased incidence of disease diagnosis. However, because women who exclusively fulfill the new criteria have a milder phenotype of the disease, it remains uncertain whether this will translate to improved outcomes.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Reddy M,Fenn S,Rolnik DL,Mol BW,da Silva Costa F,Wallace EM,Palmer KRdoi
10.1016/j.ajog.2020.08.019subject
Has Abstractpub_date
2020-08-12 00:00:00eissn
0002-9378issn
1097-6868pii
S0002-9378(20)30847-4pub_type
杂志文章abstract:OBJECTIVE:The aim of this study was to test the hypothesis that obstetricians' choice of delivery method is influenced by their risk attitude and perceived risk of complaints and malpractice litigation. STUDY DESIGN:The choice of delivery method in ambiguous cases was studied in a nationwide survey of Norwegian obstet...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.07.021
更新日期:2009-01-01 00:00:00
abstract::The deceleration delay index (DDI) is a statistical parameter computed by an on-line system which analyzes fetal monitor output for the temporal relationship between each uterine contraction and any associated deceleration of the fetal heart rate. A similar parameter describing this relationship is known to be quantit...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/0002-9378(77)90205-8
更新日期:1977-07-15 00:00:00
abstract::Glycosylated hemoglobin and glycosylated serum protein have been suggested as tools for evaluation of long- and short-term glycemic control, respectively. Twenty-six patients with gestational diabetes were prospectively studied to determine the relationship of glycosylated hemoglobin and glycosylated serum protein to ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80032-7
更新日期:1987-09-01 00:00:00
abstract::The place of symphysiotomy in the management of cephalopelvic disproportion is discussed on the basis of the existing literature, reviewing maternal mortality and morbidity after symphysiotomy and the vaginal delivery rate in a subsequent pregnancy after a previous symphysiotomy. These are compared with the outcome of...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)90653-x
更新日期:1990-07-01 00:00:00
abstract:OBJECTIVE:The route of delivery in eclampsia is controversial. We hypothesized that adverse maternal and perinatal outcomes may not be improved by early cesarean delivery. STUDY DESIGN:This was a randomized controlled exploratory trial carried out in a rural teaching institution. In all, 200 eclampsia cases, carrying ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2012.04.009
更新日期:2012-06-01 00:00:00
abstract::Antenatal in utero surgery for congenital diaphragmatic hernia has been justified by reported perinatal mortality rates of 77% to 80%. Such rates may have been subject to bias of ascertainment and may include fetuses with additional severe malformations who would not be surgical candidates. We used the Iowa Birth Defe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90425-q
更新日期:1991-10-01 00:00:00
abstract:OBJECTIVE:We used a mouse model of infection-induced preterm delivery to examine the roles of 2 adaptor proteins with central functions in Toll-like receptor signaling: MyD88 (myeloid differentiation primary-response gene 88) and TRIF (Toll/IL-1 receptor (TIR)-domain-containing adaptor protein-inducing IFN-beta). STUD...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/j.ajog.2008.08.038
更新日期:2009-01-01 00:00:00
abstract::A reusable plastic Papanicolaou smear training model was developed to teach the techniques of the Papanicolaou smear. The model design allows immediate feedback and opportunity for skills practice, yet it is efficient and cost effective. Its use is recommended for instruction in the techniques of the Papanicolaou smea...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80147-3
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to determine the relationship between nighttime delivery and neonatal encephalopathy (NE). STUDY DESIGN:The design of the study was a retrospective population-based cohort of 1,864,766 newborns at a gestation of 36 weeks or longer in California, 1999-2002. We determined the ris...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/j.ajog.2010.09.022
更新日期:2011-01-01 00:00:00
abstract::Tubal biopsy specimens were obtained at the time of tubal anastomosis in 26 previously sterilized women. Scanning electron microscopy showed that half the patients had abnormalities of tubal mucosa, including loss of mucosal folds, deciliation, and polyposis. These pathologic conditions, the morphologic features of wh...
journal_title:American journal of obstetrics and gynecology
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doi:10.1016/0002-9378(80)90015-0
更新日期:1980-09-01 00:00:00
abstract::Nonimmune hydrops fetalis can be caused by fetal chromosomal, hematologic, cardiac, or infectious conditions. A fetal blood sample obtained from percutaneous ultrasound-guided fetal blood sampling can offer vital information about the underlying cause of nonimmune hydrops fetalis, and perinatal management can be plann...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80343-5
更新日期:1987-07-01 00:00:00
abstract:OBJECTIVE:Our purpose was to determine the acid-base status of neonates with an Apgar score < or = 3 at 5 minutes and to ascertain whether accompanying acidemia is an important predictor of immediate newborn morbidity and long-term neurologic development. STUDY DESIGN:From January 1984 through December 1991 there were...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(94)70092-3
更新日期:1994-04-01 00:00:00
abstract::The effects of intravenous cocaine on heart rate and blood pressure were studied in pregnant and oophorectomized nonpregnant ewes. In response to intravenous cocaine doses of 1.0 and 2.0 mg/kg, both pregnant and nonpregnant ewes demonstrated dose-dependent increases in systolic, diastolic, mean arterial, and pulse pre...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90424-6
更新日期:1990-02-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1996-08-01 00:00:00
abstract:OBJECTIVE:How well do obstetrics and gynecology residents measure the endometrial stripe by transvaginal sonography? STUDY DESIGN:Three obstetrics and gynecology residents at the University of Texas Medical Branch from each year level were tested for their ability to perform endometrial stripe measurements. Measuremen...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:2005-11-01 00:00:00
abstract:OBJECTIVE:We studied the effect of long-term heparin treatment on bone mass during pregnancy. STUDY DESIGN:Thromboprophylaxis with heparin was given to 39 women during pregnancy for a mean of 28 weeks and for an average of 6 weeks post partum. Bone mineral density measured with single-photon absorptiometry of the dist...
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更新日期:1994-05-01 00:00:00
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更新日期:1991-12-01 00:00:00
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更新日期:1985-04-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
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更新日期:1985-01-15 00:00:00
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更新日期:1984-11-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,实务指引,评审
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更新日期:2007-09-01 00:00:00
abstract::In 46 patients with a history of habitual abortion and in 18 women with primary unexplained infertility, samples from cervical mucus and endometrial tissue have been examined for presence of T-mycoplasma, and the results compared to those obtained among 45 control subjects. Colonization of T-mycoplasma in the cervix w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1978-02-01 00:00:00
abstract::Because of the potential of dihydropyridine calcium channel blockers in the management of premature labor, we have studied the direct effects of nitrendipine on actomyosin in the pregnant and nonpregnant uterus and in the term human placenta. Actomyosin adenosinetriphosphatase in the three tissues and another model of...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:1986-02-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.ajog.2009.02.032
更新日期:2009-06-01 00:00:00
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更新日期:1991-02-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)90867-0
更新日期:1983-04-15 00:00:00
abstract::An attempt is made to define the quality of life in terms of the patient with gynecologic cancer. The effect of the diagnosis of cancer and its recurrence or its terminal state on the quality of life is considered. Possible methods of assessing the patient's individual feelings about the quality of her life are review...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:1979-08-15 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2012.07.029
更新日期:2012-10-01 00:00:00
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journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
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更新日期:1992-02-01 00:00:00