Early-onset preeclampsia with or without fetal growth restriction: an analysis of 591 cases

Objective To investigate whether fetal growth restriction (FGR) could be used as an indicator for severe early-onset preeclampsia. Methods A retrospective analysis was conducted on 591 women with early-onset preeclampsia and their fetuses and newborns in Departments of Obstetrics and Gynecology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, and the Third Affiliated Hospital of Guangzhou Medical University from January 2011 to December 2017. These cases were divided into two groups according to whether they were complicated by FGR (n=206, FGR group) or not (n=385, non-FGR group). Clinical datas were analyzed by t test or Chi-square test. Results (1) There was no significant difference between the two groups in terms of average maternal age, the ratio of primipara, the proportion of women with hypertension history, abnormal blood glucose or who received regular antenatal examination, gestational age at onset and termination or cesarean section rate. No maternal death was reported. (2) The systolic blood pressure and the incidence of hemolysis, elevated liver enzyme, low platelet count (HELLP) syndrome in the FGR group were lower than those in the non-FGR group [(167.0±21.5) vs (174.0±21.8) mmHg, t=-3.729 (1 mmHg=0.133 kPa); 6.8% (14/206) vs 13.8% (53/385), χ2=6.486]. Although the incidence of absent or reverse diastolic umbilical artery flow in the FGR group was significantly higher [24.3% (50/206) vs 14.5% (56/385), χ2=8.625], and the amniotic fluid index and placental weight were lower than those in the non-FGR group [(77.82±29.78) vs (90.53±43.83) mm, t=-2.837; (302.83±80.01) vs (330.98±61.01) g, t=-2.823], the stillbirth rate was lower[2.4% (5/206) vs 6.5% (25/385), χ2=4.605] (all P<0.05). (3) Platelet counts in the FGR group were higher than those in the non-FGR group [(189.96±65.43) vs (173.77±62.88)×109/L, t=2.923], while serum creatinine and D-dimer were lower [(70.99±22.97) vs (78.98±50.87) μmol/L, t=-2.109; (491.01±401.98) vs (635.67±386.21) μg/L, t=-2.276] (all P<0.05). There was no significant difference in 24-hour urine protein excretion between the two groups. Conclusions FGR should not be used as an indicator for severe early-onset preeclampsia. Key words: Pre-eclampsia; Fetal growth retardation