Specific hypertensive disease of pregnancy: Factors affecting infant mortality

Abstract

The infant mortality and factors affecting it were reviewed in 1,010 patients whose pregnancies were complicated by specific hypertensive disease (pre-eclampsia and eclampsia). These cases occurred among 27,028 delivered patients in Bellevue Hospital during a 15 year period ending May, 1950.The severity of the hypertensive state of its own accord, and when correlated with other factors, influenced the infant deaths. The loss was four times as great in severe cases, and in mild ones only slightly above that in the nonhypertensive patients. The incidence of eclampsia, premature separation of the placenta, and prematurity was consistently higher in the severely hypertensive patients. These conditions, in turn, contributed to the infant loss.The development of severe pre-eclampsia was independent of prenatal care. It occurred alike whether or not the patient attended the clinic. On the other hand, eclampsia ensued twice as often, and the infant mortality was decidedly greater, in patients who did not have adequate care.The infant loss was affected by the time of onset and duration. of the hypertensive state. The casualties were at their peak in the earlier weeks of gestation and with continuance of the condition.Pregnancies were terminated to lessen the hazards to mother and infant when nonconvulsive patients developed signs and symptoms of threatening eclampsia. Patients with severe pre-eclampsia treated conservatively sustained an infant loss four times greater than those with mild cases. In the latter group it was identical with that in the nonhypertensive patients. Nonviable and premature infants contributed to the deaths in a large measure, both in the severe pre-eclamptics and in those threatened with eclampsia.The incidence of eclampsia was highest in nonclinic patients, those with severe pre-eclampsia, and before the thirty-fourth week of pregnancy. The infant loss was 3½ times greater than in the pre-eclamptic group. This took place chiefly in the patients with antepartum convulsions. When eclampsia developed in a treated hypertensive patient it was usually a mild intra- or postpartum type.The majority of the patients with premature separation of the placenta had not attended the clinic. Its incidence in mild cases was identical with that among the nonhypertensive patients. It was 4½ times more prevalent in the severe cases. Almost all the infants were lost.The cesarean section rate in specific hypertensive disease was approximately 2½ times that of the total delivered patients. The increased operations were largely accounted for by those done for threatening eclampsia and premature separation of the placenta. The number of forceps deliveries was double that done in the nonhypertensive patients.The incidence of prematurity was relatively high. It was not altered by the mild cases, where it was identical with the nonhypertensive cases. However, it was almost three times more prevalent in the severely hypertensive cases. Three-fourths of the neonatal deaths of premature infants occurred within the first 48 hours of life. The increased weight of the premature liveborn infants favorably influenced their chances for survival.