The role of placental histopathological lesions in predicting recurrence of preeclampsia.

ObjectiveWe aimed to study the role of placental pathology in the prediction of preeclampsia (PE) recurrence. MethodsThe medical records and pathological placental reports of all women diagnosed with PE, during 2008-2015, were reviewed. The study population was divided according to the outcome of their subsequent pregnancy: those who did (recurrence group) or did not (no-recurrence group) develop recurrent PE. Data regarding maternal characteristics and placental maternal/fetal vascular malperfusion lesions, of the initial pregnancies, were compared. Two prediction models were generated for PE recurrence. ResultsCompared to the no-recurrence group (n=130), the recurrence group (n=96) was characterized by lower gestational age (p<0.001), longer inter-pregnancy interval (p=0.012), and higher rate of severe features (p<0.001). By logistic regression analysis composite maternal (aOR=3.05, 95%CI 1.39-6.71, p=0.005), fetal (aOR=9.31, 95%CI 3.9-22.1, p<0.001), and concurrent maternal+fetal (aOR=13.94, 95%CI 5.08-38.21, p<0.001), vascular malperfusion lesions were found to be independently associated with recurrence. A clinical prediction model accounted for 20.8% of PE recurrence (R-2=0.208, AUC=0.732), while a clinical-pathological model accounted for 34.2% of recurrence (R-2=0.342, AUC=0.80). ConclusionPlacental maternal and fetal vascular malperfusion lesions are independently associated with increased risk for PE recurrence. A clinical-pathological prediction model for recurrence of PE is superior to a prediction model based merely on clinical factors. (c) 2016 John Wiley & Sons, Ltd.