PL59. The impact of classification of hypertensive disorders of pregnancy based on the ACOG 2013 and ISSHP 2014 criteria

Abstract

Introduction A standardized classification of hypertensive disorders of pregnancy would be highly needed to achieve the comparability of the studies and the adequate management of the patients. In the last two years, the American College of Obstetricians and Gynecologists (ACOG), as well as the International Society for the Study of Hypertension in Pregnancy (ISSHP) revised the classification of hypertensive disorders in pregnancy. Objectives In Hungary, the ACOG 2002 criteria were used in the last decade to classify hypertensive disorders during pregnancy. This study aimed to determine the impact of the ACOG 2013 and ISSHP 2014 criteria on the occurrence of different forms of hypertensive disorders, as well as on perinatal outcome compared to the ACOG 2002 criteria. Methods All pregnant women with hypertensive disorders and singleton pregnancies who delivered in the 1st Dept. of Ob-Gyn. at the Semmelweis University between 1 Jan 2012 and 31 Dec 2014 ( n =755) were enrolled in this study. We determined the prevalence of different forms of hypertensive disorders according to the ACOG 2002, ACOG 2013 and ISSHP 2014 criteria. We also examined the reasons for re-classification of chronic hypertensive (CHT) and gestational hypertensive (GHT) patients to the preeclampsia (PE) group, as well as its impact on the perinatal outcome. Results The extended definition of PE according to ACOG 2013 and ISSHP 2014 classifications raised the incidence of PE by 8,2% and 17,2% compared to the ACOG 2002 classification. The most frequent cause of re-classification of GHT and CHT patients to the PE group were abnormal laboratory findings in 35% of cases according to ISSHP 2014 classification and subjective symptoms in 36% of cases according to ACOG 2013 classification. The median values of fetal birth weight were significantly lower in women with GHT (3330g (IQR: 2985–3750g) vs. 2735g (IQR: 2125–3375g), p 0,001) and CHT (3330g (IQR: 2980–3650g) vs. 2605g (IQR: 1720–3350g), p 0,001) who were re-classified to the PE group compared to those who remained in the original group. There was no statistically significant difference between the median values of gestational age at delivery and birth weight in PE patients based on ACOG 2002 and ISSHP 2014 classifications: 36 weeks (IQR: 32–38 weeks) vs. 36 weeks (IQR: 33–38 weeks), 2450g (IQR: 1540–3180g) vs. 2530g (IQR: 1650–3260g). Conclusions The extended definition of PE in both ACOG 2013 and ISSHP 2014 classifications raised the incidence of PE but did not influence perinatal outcomes significantly.