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

Abstract

IntroductionHypertensive 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.MethodsThis 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).ResultsIn 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, socio-economic 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.ConclusionRoutine 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.