Eran Weiner, MD, Noa Rymer-Haskel, MD, Ehud Grinstein, MD, Ohad Feldstein, MD,  Yossi Mizrachi, MD, Letizia Schreiber, MD, Jacob Bar, MD, MSc,  Michal Kovo, MD, PhD

Department of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel

Objective: To investigate the association between placental vascular lesions in an initial pregnancy with preeclampsia (PE), and recurrence of PE in subsequent pregnancies.

Materials and Methods – According to departmental protocol, during 2008-2014, placentas from every PE patients, were sent to histopathology examination.  PE was diagnosed according to ACOG criteria. This cohort of PE patients were followed for their subsequent pregnancy and were divided into those who developed recurrent PE in the subsequent pregnancy (Re-PE group) and those who did not developed recurrent PE (No Re-PE group). Maternal characteristics and placental pathology reports, of the initial pregnancies, were compared between the two groups. Placental lesions were classified to lesions of maternal vascular supply consistent with maternal malperfusion and lesions of fetal vascular supply consistent with fetal thrombo-occlusive disease. Multivariate logistic regression was used to control for potential known potential confounders for PE recurrence.

Results– Out of 372 PE patients, 94 included in the Re-PE group and 113 in the No Re-PE group. Maternal age and gestational age at delivery were similar between the Re-PE and the No Re-PE groups, 31±5.8vs. 31.3±6.0 years, respectively, p=0.3, and 35.9±2.7 vs. 36.4±2.9 weeks, respectively, p=0.204. Placentas from the Re-PE group had  higher rate of maternal vascular supply lesions and fetal vascular supply lesions, as compared to placentas from the No-PE group, 94.7% vs. 57.5%, respectively, p<0.001, and 57.4% vs. 16.8% respectively, p<0.001.

By logistic regression analysis, composite maternal and fetal vascular supply lesions were found to be independently associated with Re-PE, OR=15.2, 95% CI= 5.5-42.1, p<0.001, and OR=6.7, 95% CI= 3.4-13.1, p<0.001 respectively.

Conclusion –Placental maternal and fetal vascular lesions are independently associated with increased risk for recurrence of PE. In cases with preeclampsia, placental histopathology results should be used for patient counseling and prophylaxis considerations for their following pregnancies. 

Table-  aOR for the various placental vascular lesions for preeclampsia recurrence

		aOR	95% CI	p-value
Maternal vascular supply lesions	Placental hemorrhage	2.04	0.6-6.9	0.247
	Vascular lesions related to maternal malperfusion	2.1	1.1-3.9	0.016
	Villous changes related to maternal malperfusion	3.8	2-7.1	<0.001
	Composite maternal vascular supply lesions	15.2	5.5-42.1	<0.001
Fetal vascular supply lesions	Vascular lesions consistent with FTOD	3.6	1.5-8.5	<0.001
	Villous lesions consistent with FTOD	6.1	2.6-14	<0.001
	Composite fetal vascular supply lesions	6.7	3.4-13.1	<0.001