Adverse Outcomes in Pregnancy with Chronic Hypertension with and without Superimposed Preeclampsia in Urban South Indian Population: A Prospective Observational Study

Abstract

Introduction: Pregnant women with chronic hypertension and who developed superimposed Preeclampsia (PE) had a higher rate of adverse maternal and perinatal outcomes. Prospective data on the outcome of pregnancies with chronic hypertension are sparse. Aim: To evaluate the maternal and perinatal outcomes in pregnancies complicated by chronic hypertension with and without superimposed PE in South Indian population. Materials and Methods: A two group, parallel, prospective observational study was carried out in 270 women with singleton pregnancy and chronic hypertension with and without superimposed PE and who received antenatal care and delivered in the Department of Obstetrics and Gynaecology at Fernandez hospital, Hyderabad, Telangana, India from March 2019 to February 2020. A total of 180 women had chronic hypertension without superimposed PE and 90 had superimposed PE (group A, 180 cases; group B, 90 cases). The medical records were reviewed with specific reference to the treatment, development of Foetal Growth Restriction (FGR), maternal and perinatal outcomes. FGR was considered as the primary outcome variable. Secondary variables were stillbirth rate, low birth weight, Neonatal Intensive Care Unit admissions, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) at 5 minutes, gestational age at delivery, caesarean section rate and maternal complications. Categorical variables were assessed by Pearson’s Chi-square test. Continuous variables were assessed by unpaired student t-test. Results: The mean maternal age in group A was 32±5 years and in group B was 30±4 years. Adverse maternal outcomes like abruption, Haemolysis, Elevated liver enzymes, and Low platelets (HELLP) syndrome, and pulmonary oedema were all low in women without superimposed PE than those with superimposed PE (1.6% vs 12%, p≤0.001). There were no maternal deaths in either group. Compared to group A, group B showed higher FGR rate (15.5%vs 51.1%, p<0.001), preterm deliveries (<37 weeks) (50.5% vs 80% p<0.001), stillbirths (0 vs 13.3%), low APGAR at 5 minutes (1.1% vs 16.6%%, p<0.001), low birth weight (21.2% vs 71.1%, p<0.001), NICU admissions (14.4% vs 43.3%, p<0.001). There was no significant difference in the caeserean section rate between the groups (69.4% vs 74.4%, p=0.39). Conclusion: Maternal and perinatal morbidity was higher in women having chronic hypertension with superimposed PE. They need vigilant maternal and foetal surveillance and should be counseled about all the possible adverse outcomes.