Maternal and Perinatal Outcomes in Hypertensive Disorders of Pregnancy and Factors Influencing It: A Prospective Hospital-Based Study in Northeast India

Abstract

Introduction Hypertensive disorders frequently complicate pregnancy and contribute substantially to maternal and perinatal morbidity and mortality. Identification of risk factors for hypertensive disorders of pregnancy (HDP) can help determine the particular patient group which requires appropriate intervention. Methods This prospective cross-sectional hospital-based study conducted from January 2016 to January 2019 included all pregnant women beyond 20 weeks of gestation complicated by HDP. The objectives were to determine the incidence of HDP and associated maternal and perinatal mortality and morbidity rates along with factors influencing it. Data collected were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed with the Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY). Results In our study, out of 5460 deliveries, 402 (7.4%) cases had HDP, 27.6% had gestational hypertension, 27.6% had mild preeclampsia, 33.6% had severe preeclampsia, and 11.2% had eclampsia. Fifty-four (13.4%) cases required admission in the intensive care unit and 12 (2.9%) ended in maternal deaths. The cause of maternal mortality was cerebral hemorrhage in eight (66.6%) cases and pulmonary edema in four (33.3%) cases. All maternal deaths occurred in women with severe preeclampsia and eclampsia and eclampsia was significantly higher. Maternal deaths were more when systolic blood pressure (SBP) was ≥ 160mmHg, diastolic blood pressure (DBP) was ≥ 110mmHg, significantly more with 3+ proteinuria, but no association was found with age, parity, booking status, socioeconomic status, gestational age, or mode of delivery. All mothers with HDP received treatment with antihypertensives. There were 60 (14.9%) cases of perinatal mortality. Perinatal deaths were more in unbooked cases and preterm HDP, significantly more with SBP ≥160 mmHg, DBP ≥110 mmHg and ≥2+proteinuria, but no association was found with parity or mode of delivery. Besides mortality, there was a significant burden of maternal and perinatal morbidity, which was more in women with severe preeclampsia and eclampsia. Conclusion Routine antenatal screening for HDP in all pregnant women with appropriate and timely interventions in women at risk may help reduce HDP-related maternal and perinatal morbidity and mortality.

Perinatal outcome in pregnancies associated with hypertension: A prospective cohort study in a rural tertiary care teaching hospital of North India

“…In our study, the perinatal mortality rate was 16.9% because of HDP which is similar as reported by other authors from 12.4% to 20.4%[ 3 17 18 19 20 21 ] Types of HDP seen in our study are similar to the findings of Sharma et al . who observed 6.92% HDP with PE contributing to 50.2%, E – 35.7%, GH – 12.5%, and CH – 1.6%.…”

“…[ 16 ] Different studies done in India show HDP as a leading cause of adverse perinatal outcome and mortality. [ 17 18 19 ]…”

“…We observed perinatal mortality of 28.6% in women with eclampsia followed by 16.4% in PE and 7.1% in gestational hypertension suggesting that women in eclampsia and PE were at highest risk for an adverse perinatal outcome which is in accordance with the observations of Panda et al . [ 19 ] A WHO multicountry survey also reported that there was about three-fold increased risk of perinatal death in women with PE and five-fold in women with eclampsia. [ 22 ]…”

Antihypertensive Medications for Severe Hypertension in Pregnancy: A Systematic Review and Meta-Analysis

“…Hypertensive disorders are responsible for 14% of maternal deaths worldwide [ 17 ]. Maternal mortality is more likely to occur when the BP ≥ 160/110 mmHg [ 18 ]. Based on a retrospective study over 5 years (2011–2016), 57.3% of pregnant women with preeclampsia had severe hypertension called severe preeclampsia [ 19 ].…”

Gestantes em Cruzeiro do Sul, Acre: características demográficas e socioeconômicas, ocorrência e fatores associados aos distúrbios hipertensivos na gravidez

“…Further, maternal complications include disseminated vascular coagulation, placental abruption, stroke, multiple organ failure and maternal death (Unger et al, 2020). Studies conducted in different parts of the world showed that among the significant repercussions for the conceptus associated with HDP are intrauterine growth restriction (Mateus et al, 2019), low birth weight, prematurity (Lugobe et al, 2020), severe respiratory disease, admission to the Intensive Care Unit (ICU) and perinatal mortality (Panda et al, 2021;Broekhuijsen et al, 2015).…”