A PROSPECTIVE STUDY OF CASES OF PREGNANCY INDUCED HYPERTENSION AND MATERNAL AND PERINATAL OUTCOME AT TERTIARY CARE HOSPITAL

Abstract

Background: Pregnancy Induced hypertension continues to be rampant globally and is associated with high perinatal and maternal mortality and morbidity. It is still one of the most important and intriguing unsolved problems in obstetrics. Hypertensive disorders in pregnancy account for approximately 7 to 15% of all pregnancies and nearly 25% of antenatal ward admissions. The condition complicates about 10% of pregnancies and is responsible for 14% of maternal deaths, 15% of perinatal deaths, and 30% of maternal near misses worldwide. Hypertensive disorders in pregnancy (PIH) are a group of disorders that range from pre-existing chronic hypertension in the index pregnancy to complex multisystem disorders such as preeclampsia, which can lead to complications such as eclampsia, HELLP syndrome, acute renal failure, pulmonary edema, stroke, and left ventricular failure. Though not preventable, early detection and proper intervention can signicantly reduce complications. This is achievable with Prenatal care at all levels. However, there is an unmet need in recognizing and managing PIH and its complications in low and middle-income countries due to pregnancy myths and misconceptions, transportation challenges, low socioeconomic status, and a lack of easy and expert antenatal care requiring a multidisciplinary approach, a lack of accurate prediction methods, and a scarcity of high dependency units (HDU). Early detection of a milder form of disease, corticosteroid administration, and careful timing of delivery can all help improve the outcome. In light of this, we designed and conceived the current study with the goal of studying the maternal and perinatal outcomes of Hypertensive Disorders of Pregnancy at a tertiary care hospital. Furthermore, data from antenatal females with PIH admitted for safe connement were collected and classied into the following categories: GHTN, Preeclampsia, Chronic Hypertension, Chronic Hypertension superimposed with preeclampsia, and eclampsia. Finally, the method of delivery (vaginal/caesarean section) in each category of patients was examined. The study's ndings will assist us in determining the scope of the problem in our area and estimating the fetal and maternal complications associated with it. Methods: All patients beyond 20 weeks of pregnancy with pregnancy induced hypertension admitted in department of Obstetrics and Gynaecology of MGM Medical College over a period of 18 months after approval from Institutional ethical committee was taken into consideration. The objective of the study was to analyze the cases of gestational hypertension, Chronic Hypertension, Chronic Hypertension superimposed with preeclampsia, pre-eclampsia and eclampsia and their maternal outcome in terms of mode of delivery and complications. Perinatal outcome in relation to neonatal complications was also studied. The frequency and percentage for socio-demographic variables, mode of delivery and complications were analyzed. Results: Pregnancy Induced Hypertension cases accounted for 415 cases were enrolled during study period; The most common PIH presentation was pre-eclampsia, followed by severe pre-eclampsia, gestational hypertension, antepartum eclampsia. Maternal morbidity and mortality were observed in 37.6% of the women and 3.6%, respectively in our study. Abruption, wound infection, and eclampsia were the most common complications, accounting for 11%, 9%, and 7.7% of all cases, respectively. 48.2% of babies were shifted to mother side, followed by 41.6% were shifted to SNCU, 7.9% were Intrauterine deaths and least 2.1% were Still birth respectively Conclusions: Though the incidence of pre-eclampsia and eclampsia is on the decline, still it remains the major contributor to poor maternal and fetal outcome. Regular antenatal checkups, early diagnosis, prompt multidisciplinary treatment, optimum timing of delivery reduces the incidence of complications and the maternal mortality. Early referral and management of these cases at centers with advanced neonatal facilities will reduce the perinatal mortality