Pregnancy-Related Hypertension in Multigravidas with Previous Cesarean Delivery

Abstract

Pregnancy-related hypertension is a significant contributor to maternal as well as perinatal morbidity and mortality and is found to be responsible for 25% of maternal mortality (1). There are several factors that can place a woman at a higher risk of developing pregnancy hypertension. Potential risk factors associated with the development of hypertension in pregnancy include multiple gestation, nulliparity, pre-existing diabetes, high body mass index (BMI), advanced maternal age, and history of hypertension in previous pregnancies (2).Pregnancy-related hypertension is generally considered as a disease of first pregnancy. It is less common in subsequent pregnancies. If a woman was normotensive during her first pregnancy, the possibility of developing hypertension in a subsequent pregnancy was much lower (3). There are studies documenting the risk of recurrence (4, 5) and occurrence of pregnancy hypertension in multigravidas (6).Not many studies have been performed to determine the changing incidence of pregnancy-related hypertension in multigravidas. It is acknowledged that the incidence of cesarean delivery has been on the rise. It is also documented that a scarred uterus can affect the vasculature of the uterus and may subsequently affect the placentation in pregnancy (7). It is also established that the primary pathology of preeclampsia appears to be at the maternal-fetal interface characterized by poor trophoblastic invasion of the uterus and that it subsequently alters the utero-placental blood flow (8). It is reported that there is an increased preeclampsia risk in the following pregnancies after cesarean delivery (9).The present study is an attempt to recheck the influence of prior cesarean delivery on incidence of pregnancy-related hypertension. MethodsThis was a prospective case-control non-interventional study conducted from September 2015 to August 2016 in maternity facilities attached to a medical college in southern India on the west coast. Pregnancy-Related Hypertension in Multigravidas with Previous Cesarean DeliveryObjective: To investigate whether prior cesarean delivery is associated with occurrence of pregnancy hypertension. Methods:A prospective case-control study in consenting eligible consecutive 475 pregnancies with prior cesarean delivery and age-and paritymatched 475 pregnancies with previous vaginal delivery. Results were subjected to multiple logistical regression analysis.Results: Body mass index, birth interval, and neonatal birth weight were comparable between the study groups. In women with prior cesarean delivery, pregnancy-related hypertension was significantly higher [15.9% vs. 6.7% in those with prior vaginal delivery, p<0.05; odds ratio (OR), 2.6; 95% confidence interval (CI), 1.707-4.072]. A higher proportion of women were found to develop hypertension by 32 weeks of pregnancy. In both the study groups, the development of pregnancy-related hypertension was found to be higher in the age group of 20-25 years, birth interval of >18 months, second gravidas, and in the gestation p...

Previous Cesarean Section and the Risk of Preeclampsia: A Meta-analysis

“…In the end, 7 studies were included in the present meta-analysis (Figure 1). These studies were four cohort studies [15,20,23,24], two casecontrol [21,25], and one cross-sectional [26] involving 423940 participants. In this systematic review, 4 studies out of 7 were adjusted based on confounding variables.…”

“…Abnormal uteroplacental blood flow and unusual trophoblastic invasion due to uterine changes in previous cesarean section may result in preeclampsia in subsequent pregnancies [20]. The results of studies have shown the relationship between previous cesarean delivery and the risk of preeclampsia [14,20,21].…”