ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG THAI PHỤ MẮC TIỀN SẢN GIẬT TỪ 28 TUẦN TẠI BỆNH VIỆN PHỤ SẢN HÀ NỘI

Abstract

Objective: To describe the clinical and laboratory characteristics of pregnant women with preeclampsia (PE) from ≥28 weeks’ gestation who were followed and treated at Hanoi Obstetrics and Gynecology Hospital. Subjects and methods: Cross-sectional descriptive study of 104 pregnant women diagnosed with PE from 28 weeks, enrolled from January 2024 to September 2025. Baseline risk factors, temporal clinical manifestations, and laboratory indices (hematology, biochemistry, PlGF, sFlt-1) were recorded. Results: The cohort had a high baseline risk: age ≥31 years 58.7%; BMI ≥30 kg/m² 25.0%; IVF 25.0%; chronic hypertension 9.6%; prior gestational hypertension 11.6% and prior PE 6.7%. Early-onset PE (<34 weeks) accounted for 61.5%, higher than late-onset PE (≥34 weeks) at 38.5%. Clinical severity increased over time: severe hypertension 8.7% (at admission) → 27.9% (at confirmation of severe PE) → 39.4% (at delivery); refractory headache 6.7% → 22.1% → 31.7%. Edema was present in 74%. Very severe complications (pulmonary edema, eclampsia, HELLP) were rare. Laboratory parameters trended unfavorably: proteinuria increased from 1.80 ± 0.26 to 1.98 ± 0.38 and 2.80 ± 0.50; platelets declined slightly from 231.98 ± 7.44 to 223.52 ± 7.52 and 216.40 ± 8.52 (×10⁹/L); AST/ALT and creatinine rose to moderate levels. Placental malperfusion/Doppler abnormalities were prominent at the time severe preeclampsia was diagnosed (57.1%). Angiogenic markers showed a clear gestational-age–dependent imbalance: sFlt-1 was higher at 28–34 weeks and decreased after ≥34 weeks, whereas PlGF increased with advancing gestation. Consequently, the sFlt-1/PlGF ratio fell markedly: 182.5 (28–32 weeks) → 132.5 (32–34 weeks) → 55.5 (≥34 weeks), p < 0.001. Conclusions: Pregnant women with PE from ≥28 weeks at this center had high baseline risk, exhibited a time-dependent worsening of clinical features, and demonstrated a characteristic laboratory profile (increasing proteinuria, mild platelet decline, higher liver enzymes/creatinine, and an sFlt-1/PlGF imbalance), particularly in early-onset cases