Severe antepartum hypertension and associated peripartum morbidity among pregnant women in an urban tertiary care medical center.

Abstract

Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality. Although acute severe hypertension carries with it a poor prognosis, treatment is often delayed and not universal. A total of 654 patients were assessed for the impact of hypertensive disorders of pregnancies on maternal and fetal morbidity and divided into three groups: normotensive (Group I, N=306), non-severe hypertension (Group II, N=248) and severe-range hypertension with blood pressure (BP) episodes ≥160 systolic or ≥105 diastolic (Group III, N=100). Retrospective demographic and medical information was abstracted from patients' medical records to collect study data. The main outcomes assessed were composite maternal adverse events,fetal adverse events, and time to treatment. Patients in Group III had higher systolic (182 vs 155 vs 133) and diastolic (106 vs 95 vs 81) BPs compared to patients in Groups II and I. Patients in Group III had a significantly higher incidence of maternal adverse events (26.0% vs 6.5% vs 2.0%, respectively; p<0.001) and higher neonatal composite adverse events (52.0% vs 17.7% vs 26.1%, respectively; p<0.001) as compared to patients in Groups II and I. Only 52.2% of patients in Group III were treated within recommended 60minutes or less. Patients with severe hypertension antepartum have higher associated maternal and fetal adverse events while treatment is often delayed. Further studies should evaluate the effects of adequate time to treatment for severe hypertension. Steps should also be taken to standardize identification and reporting of severe maternal morbidity.