P 30 Clinical characteristics of patients whose preeclampsia status changes

Abstract

Introduction By definition, elevated blood pressure is central to preeclampsia (PE) diagnostics. However, blood pressure varies with many factors, including physical activity, hydration, and stress. Degree of proteinuria, another finding diagnostic of PE, may also fluctuate due to dipstick test inaccuracy, hydration level, and specimen collection technique. Thus, a PE diagnosis made according to current criteria does not always accurately represent the final clinical picture. Objectives To compare the clinical profiles of 1) women who receive a PE diagnosis but later cease to fulfill the diagnostic criteria for PE, 2) women who cycle between diagnostic groups, and 3) women who consistently fulfill the diagnostic criteria for PE. Patients and methods The PEACH (PreEclampsia, Angiogenesis, Cardiac dysfunction and Hypertension) study is an ongoing longitudinal prospective study being conducted at two hospitals in Copenhagen. Approximately 300 women presenting to the obstetrics departments of these hospitals with signs or symptoms of PE have already been recruited and followed to the end of pregnancy with serial blood tests and repeated cardiac function measurements obtained using the USCOM-1A device. We compare clinical variables (e.g. blood pressure at multiple time points, dipstick proteinuria, symptoms, pre-pregnancy body mass index, age) and USCOM-derived cardiac function measurements (stroke volume, cardiac output, systemic vascular resistance and their indexed values) across groups of women with varying clinical courses. Results and conclusion We present clinical and hemodynamic profiles for PEACH women who can consistently be classified as having PE and those who cannot. It is not unusual for a woman who initially meets the criteria for PE to later stabilize and be re-classified with gestational hypertension or no hypertensive disorder at all; others continue to have blood pressure fluctuations around the levels considered diagnostic for PE. Women who initially present with hypertension and proteinuria but later appear to become non-preeclamptic are an interesting group of patients whose management presents a challenge. A new diagnostic paradigm is urgently needed; however, until PE diagnosis is revolutionized, it may be beneficial to add a temporal component to the current criteria.