Document Detail

Late first-trimester placental disruption and subsequent gestational hypertension/preeclampsia.
MedLine Citation:
PMID:  15738029     Owner:  NLM     Status:  MEDLINE    
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 villus 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/preeclampsia 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.
Richard K Silver; R Douglas Wilson; John Philip; Elizabeth A Thom; Julia M Zachary; Patrick Mohide; Maurice J Mahoney; Joe L Simpson; Larry D Platt; Eugene Pergament; Douglas Hershey; Karen Filkins; Anthony Johnson; Ronald J Wapner; Laird G Jackson;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  105     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-01     Completed Date:  2005-04-07     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  587-92     Citation Subset:  AIM; IM    
Evanston Hospital of Northwestern University Medical School, Evanston, Illinois 60201, USA.
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MeSH Terms
Amniocentesis / adverse effects*
Chorionic Villi Sampling / adverse effects*
Hypertension, Pregnancy-Induced / etiology*
Pre-Eclampsia / etiology*
Pregnancy Trimester, First
Grant Support

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