Abstract
To evaluate the prevalence of hypertensive disorders, perinatal outcomes (preterm infants, low birthweight infants and Apgar score < 7 at the 5th minute and fetal deaths) and the cesarean rates in pregnant women hospitalized for delivery at the Maternidade Hilda Brandão da Santa Casa de Belo Horizonte, Belo Horizonte, state of Minas Gerais, Brazil, from March 1, 2008 to February 28, 2018. A case-control study was performed, and the groups selected for comparison were those of pregnant women with and without hypertensive disorders. Out of the 36,724 women, 4,464 were diagnosed with hypertensive disorders and 32,260 did not present hypertensive disorders RESULTS: The prevalence of hypertensive disorders was 12.16%; the perinatal outcomes and cesarean rates between the 2 groups with and without hypertensive disorders were: preterm infants (21.70% versus 9.66%, odds ratio [OR] 2.59, 95% confidence interval [CI], 2.40-2.80, p < 0.001); low birthweight infants (24.48% versus 10.56%; OR 2.75; 95% CI, 2.55-2.96; p < 0.001); Apgar score < 7 at the 5th minute (1.40% versus 1.10%; OR 1.27; 95% CI, 0.97-1.67; p = 0.84); dead fetuses diagnosed prior to delivery (1.90% versus 0.91%; OR 2.12; 95% CI, 1.67-2.70; p < 0.001); cesarean rates (60.22% versus 31.21%; OR 3.34; 95% CI, 3.14-3.55; p < 0.001). Hypertensive disorders are associated with higher rates of cesarean deliveries and higher risk of preterm infants, low birthweight infants and a higher risk of fetal deaths.
Highlights
Hypertensive disorders complicate up to 10% of all pregnancies and are one of the main causes of maternal and perinatal morbidity and mortality, besides playing a key role in prematurity.[1,2,3] Hypertensive disorders are classified into four categories: 1) pre-eclampsia (PE)-eclampsia, 2) chronic hypertension, 3) chronic hypertension with superimposed PE and 4) gestational hypertension.[1,4,5,6] Pre-eclampsia affects 2 to 8% of pregnant women.[6]
The present study aimed to evaluate the prevalence of hypertensive disorders, perinatal outcomes and the cesarean rates in pregnant women hospitalized for delivery at the Maternidade Hilda Brandão da Santa Casa de Belo Horizonte, Belo Horizonte, state of Minas Gerais, Brazil
The increased prevalence over the years was a consequence of the higher number of high-risk pregnancy patients referred to the Maternidade Hilda Brandão (►Fig. 2)
Summary
Hypertensive disorders complicate up to 10% of all pregnancies and are one of the main causes of maternal and perinatal morbidity and mortality, besides playing a key role in prematurity.[1,2,3] Hypertensive disorders are classified into four categories: 1) pre-eclampsia (PE)-eclampsia, 2) chronic hypertension (of any etiology), 3) chronic hypertension with superimposed PE and 4) gestational hypertension.[1,4,5,6] Pre-eclampsia affects 2 to 8% of pregnant women.[6] The main maternal complications in PE are eclampsia, coagulopathy (disseminated intravascular coagulation), stroke, pulmonary edema, severe renal failure, liver infarction or hemorrhage, myocardial infarction, retinal injury, placental abruption and death.[1,5,6,7,8] Eclampsia affects $ 3.2% of patients suffering from PE with severe features.[6,9] It occurs in a ratio of 1/2000 deliveries in developed countries and from 1/100 to 1/1,700 deliveries in developing countries.[9] HELLP syndrome (H: hemolysis; EL: elevated liver enzymes; LP: low platelet) is associated with high rates of maternal morbidity and mortality.[1,6,10,11] Its occurrence is $ 1 to 2% in patients with PE with severe features.[12] In PE, placental ischemia may lead to fetal growth restriction and placental abruption with a subsequent increased risk of prematurity. It affects from 20 to 50% of chronically hypertensive patients.[20,24,25]
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