Blood Pressure Levels and Maternal Outcome in Women with Preeclampsia – a Retrospective Study from a Large Tertiary Obstetric Centre

Abstract

Introduction Patients with high blood pressure levels are at high risk for acute complications as well as serious long-term consequences. Women with preeclampsia often experience very high blood pressure levels during pregnancy and postpartum and are also known to have a higher cardiovascular risk in later life. Material and Methods In our single-centre retrospective cohort study, we analysed 158 pregnancies complicated by preeclampsia in regard to maternal outcome. We divided the patient cohort into three subgroups according to the blood pressure levels during hospital stay. Results Pre-existing arterial hypertension was significantly more common in patients with a hypertensive crisis (systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure ≥ 120 mmHg) during pregnancy than in patients with moderate or severe hypertension (p = 0.001). Women with a hypertensive crisis had an unfavourable outcome compared to women with lower blood pressure levels. These women developed a HELLP-syndrome significantly more often (p = 0.013). Moreover, most of the women with a hypertensive crisis during pregnancy were still hypertensive at hospital discharge (p = 0.004), even though they were administrated antihypertensive agents more often (p < 0.001) compared to women with lower blood pressure values. Conclusion Preeclamptic women with hypertensive crises should be identified quickly and monitored closely to avoid further complications. Standardized follow-up programs are lacking, but especially these patients seem to be at high risk for persistent hypertension and increased cardiovascular morbidity and therefore should receive specialist follow-up, including hypertensiologists, cardiologists and gynaecologists. Large prospective trials are required for a better understanding of these interrelations and to develop a specific follow-up program.

The Role of Hypertension for Maternal Outcomes of Women with HELLP Syndrome – a Retrospective Study from a Tertiary Obstetric Center

“…In a previous study, we showed that patients with preeclampsia and very high blood pressure during pregnancy developed HELLP syndrome significantly more often than patients with lower blood pressure levels [12]. Therefore, strict blood pressure control might be a possible preventative option to delay or even avoid the severe complications of preeclampsia and related disorders such as HELLP syndrome.…”

“…According to previous studies on maternal outcomes with preeclampsia and based on the current international guidelines on arterial hypertension, we divided the patients into three groups according to their maximum prepartum blood pressure 12 13 14 :…”

“…According to previous studies on maternal outcomes with preeclampsia and based on the current international guidelines on arterial hypertension, we divided the patients into three groups according to their maximum prepartum blood pressure [12,13,14]: ▪ Group 1 included all patients with mild to moderate or no hypertension (blood pressure below 160/110 mmHg). ▪ Group 2 consisted of patients with severe hypertension (systolic blood pressure between 160 and 179 mmHg and/or diastolic pressure between 110 and 119 mmHg) ▪ Group 3 included patients with hypertensive crisis (systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure ≥ 120 mmHg).…”

“…A previous study focusing on preeclampsia pointed out that the likelihood of an adverse maternal outcome is elevated when maternal blood pressure is high 12 . Based on this study, we hypothesized that patients with HELLP syndrome and hypertension have a higher risk of adverse outcomes compared to normotensive patients.…”

Perinatal Outcome and Its Association with Blood Pressure Levels in Women with Preeclampsia

“…This led us to the question whether a classification of preeclampsia into different degrees of severity according to maternal blood pressure levels could be helpful for perinatal risk stratification. In a previous study, it could be shown that the level of hypertension in preeclamptic women is an independent marker for maternal outcome [ 12 ]. It remains uncertain if there is a direct impact on the mode of delivery and neonatal outcome.…”