Outcomes Of Hypertensive Disorders Research Articles

Lactate dehydrogenase as a biochemical marker for prediction of maternal and perinatal outcomes in hypertensive disorders in pregnancy

Hypertensive disorder of pregnancy includes new onset hypertension in pregnancy that is gestational hypertension and already existing hypertension that is chronic hypertension and gestational hypertension sometimes worsened by preeclampsia. Preeclampsia can cause complications such as eclampsia, HELLP syndrome, renal failure, pulmonary edema, stroke, and left ventricular failure. We aim to assessthe predictive role ofLactate Dehydrogenase value in Hypertensive disorders in pregnancy.After obtaining the informed consent, pregnant patients who were visiting Tertiary care centre and who were more than 28 weeks period of gestation were enrolled. Patients from both antenatal OPD clinics and from those who were presenting in emergency were included in this study. Serum levels of LDH were tested. Patients were monitored till delivery and 6 weeks following childbirth.The Mean serum levels of lactate dehydrogenase (LDH) in eclamptic group was 1495.000±859.1230, 804.569±224.5519 in severely preeclamptic group and in mild preeclamptic group ,mean LDH levels were 520.062±110.3944. The difference between both the groups was statistically significant (p < 0.001).Women with serum LDH levels > 800 IU/L and LDH levels between 601-800 IU/L, experienced considerably greater complications in preeclamptic-eclamptic group as compared to those with serum LDH levels < 600 IU/L.Thepreeclamptic-eclamptic group of women had increased serum LDH levels. Greater LDH levels were linked to worse outcomes for mothers including placental abruption, hemolysis elevated liver enzymes low platelet count (HELLP syndrome), pulmonary edema and maternal death and they were also linked to fetal complications including intrauterine fetal death (IUFD), intrauterine growth restriction and neonatal intensive care unit (NICU) admission.

Predictors, prevalence and outcome of hypertensive disorders in pregnancy in Nigerian tertiary health facilities.

Determine prevalence, risk factors and outcomes of hypertensive disorders in pregnancy (HDP). Cross-sectional analysis of data captured in the Maternal and Perinatal Database for Quality, Equity and Dignity (MPD-4-QED) between September 2019 and August 2020. Fifty-four referral level facilities in Nigeria. Women whose pregnancy ended (irrespective of the location or duration of pregnancy) or who were admitted within 42 days of delivery. Descriptive statistics and multilevel mixed-effects logistic regression models. Prevalence of HDP, sociodemographic and clinical factors associated with HDP and perinatal outcomes. Among the 71 758 women 6.4% had HDP and gestational hypertension accounted for 49.8%. Preeclampsia and eclampsia were observed in 9.5% and 7.0% of all pregnancies, respectively. The predictors of HDP were age over 35 years (OR1.96, 95% CI 1.82-2.12; p < 0.001), lack of formal educational (OR 1.18, 95% CI 1.06-1.32; p = 0.002), primary level of education (OR 1.20, 95% CI 1.03-1.4; p < 0.002), nulliparity (OR 1.21, 95% CI 1.12-1.31; p < 0.001), grand-multiparity (OR 1.36, 95%CI 1.21-1.52; p < 0.001), previous caesarean section (OR 1.26, 95%CI 1.15-1.38; p < 0.001) and previous miscarriage (OR 1.22, 95% CI 1.13-1.31; p < 0.001). Overall 3.7% of the patients with HDP died, with eclampsia having the highest case fatality rate of 27.9%. Stillbirth occurred in 11.9% of pregnancies with hypertensive disorders. Hypertensive disorders in pregnancy are not uncommon in Nigeria. They are associated with adverse outcomes with over one-quarter of women with eclampsia dying. The main predictors include older age, poor education, extremes of parity and previous CS or miscarriage. Maternal and perinatal outcomes are poor with about a quarter developing complications and about 1 in 10 having stillbirths.

Retinal Microvascular Characteristics and Outcomes in Hypertensive Disorders of Pregnancy.

Background Hypertensive disorders of pregnancy (HDP) is a continuum of chronic hypertension, gestational hypertension, preeclampsia, and eclampsia in increasing severity, associated with a higher risk of complicated pregnancies and poor neonatal outcomes. This multisystem involvement can be assessed by fundoscopy, which serves as an indicator for generalized microvascular abnormalities. Our study aims to evaluate the correlation of hypertensive retinopathy with the severity of HDP and maternal and fetal outcomes. Materials and methods The study was conducted at a tertiary care hospital in Vijayapura from October 2021 to March 2022 among admitted cases of HDP. Detailed history, blood pressure (BP) measurement, obstetric examination, and fundoscopy were performed for all cases. Patients were followed up until the 10th postnatal day. The mode of delivery, birth weight, gestational age at birth, and any other neonatal outcomes were noted. Results We included 94 preeclampsia/eclampsia patients with a median age of 23 years, 51 (54.3%) being primigravida. Patients with chronic hypertension, gestational hypertension, and chronic hypertension superimposed by preeclampsia/eclampsia were excluded. The most common symptom in mothers was headache (23.4%), followed by blurring of vision (20.2%) and epigastric pain (5.3%) with a significant association (p < 0.05). Thirty-two cases (34%) had preterm deliveries with a positive association with the severity of retinopathy (p < 0.05). The magnitude of hypertensive retinopathy was 56.3% (53 cases), the severity of which significantly correlated to the severity of HDP (p < 0.05). We report 8.5% neonatal mortality and 22.3% small for gestational age (SGA) with a positive association with HDP severity (p < 0.05). There was no correlation between serum creatinine levels and the severity of retinopathy and fetal outcome. Conclusion The occurrence and severity of hypertensive retinopathy increase with increasing severity of HDP. Complaints, such as headache, blurred vision, and epigastric pain, are reported higher in cases with retinopathy. The severity of retinopathy may be used as an indicator of fetal morbidity; however, studies with large sample sizes and advanced tools are required to quantify the cause-effect relationship. The retinopathy associated with HDP resolves naturally with BP control postnatally.

Prognostic significance of liver function tests in predicting maternal and fetal outcomes in Hypertensive Disorders of Pregnancy

Prognostic significance of liver function tests in predicting maternal and fetal outcomes in Hypertensive Disorders of Pregnancy

The role of serum uric acid levels in the evaluation and prediction of adverse outcomes in hypertensive disorders of pregnancy

The role of serum uric acid levels in the evaluation and prediction of adverse outcomes in hypertensive disorders of pregnancy

Serum Lactate Dehydrogenase as an Indicator of Maternal and Neonatal Outcomes in Hypertensive Disorders of Pregnancy

Serum Lactate Dehydrogenase as an Indicator of Maternal and Neonatal Outcomes in Hypertensive Disorders of Pregnancy

Serum Macrophage Colony-Stimulating Factor Relates to the Severity and the Pregnancy Outcomes in Hypertensive Disorders Complicating Pregnancy

Purpose: This study aimed to assess the predictive value of macrophage colony-stimulating factor (M-CSF) in the first trimester for hypertensive disorders complicating pregnancy (HDCP) and its association with disease severity and adverse pregnancy outcomes. HDCP pose significant risks to both maternal health and fetal health. M-CSF is implicated in the pathogenesis of HDCP by promoting inflammation and endothelial damage. Methods: Serum levels of M-CSF were measured using an enzyme-linked immunosorbent assay, and clinical characteristics and pregnancy outcomes were compared between groups. Results: Pregnant women with HDCP had significantly higher levels of proteinuria, systolic blood pressure, and diastolic blood pressure compared to those with normal pregnancy. Among patients with HDCP, the severity of disease correlated positively with serum levels of M-CSF. Furthermore, M-CSF levels in the first trimester were significantly associated with adverse pregnancy outcomes. The findings suggest that M-CSF may serve as a potential biomarker for predicting HDCP and its severity, as well as adverse pregnancy outcomes. Conclusions: Early detection and monitoring of M-CSF levels could aid in identifying high-risk pregnancies and implementing appropriate interventions to improve maternal and fetal outcomes.

Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices.

Objective Doppler velocimetry is an established method of antepartum fetal surveillance in pre-eclampsia. Cerebroplacental ratio detects the centralization of fetal blood flow and the insufficiency in placental circulation. It is postulated to be a better marker of perinatal outcome than either vessel Doppler alone. The current study aims to assess the cerebroplacental ratio as a predictor of adverse perinatal outcomes and compare it to the systolic/diastolic (S/D) ratio of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy. Material and methods The present prospective observational cohort study included 100 patients with hypertensive disorders of pregnancies between 32 and 37 weeks. Ultrasound with Doppler was done and the following parameters were assessed: fetal biometry, amniotic fluid index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, S/D ratio of umbilical artery, S/D ratio of middle cerebral artery, and cerebroplacental ratio. Sensitivity, specificity, positive and negative predictive values were calculated for the cerebroplacental ratio and S/D ratios of umbilical and middle cerebral arteries. McNemar's test was used for the comparison of sensitivity and specificity. Results Thirty-two patients had an abnormal cerebroplacental ratio. Adverse perinatal outcomes such as a cesarean section for fetal distress, small for gestational age, APGAR < 7 at 1 and 5 minutes, NICU admission, and perinatal mortality were more in the group with abnormal cerebraplacental ratio and the difference was statistically significant. Conclusion The cerebroplacental ratio is a more reliable predictor of adverse perinatal outcomes and should be routinely calculated during obstetrical Doppler for antepartum fetal surveillance in case of hypertensive disorders of pregnancy. It suggested that the cerebroplacental ratio may be calibrated in the software of the Doppler ultrasonography machine for routine use in high-risk pregnancies.

Quality of antenatal care and outcomes of Hypertensive Disorders in Pregnancy among antenatal attendees: A comparison of urban and periurban health facilities in Ghana.

Rural-urban-peri urban disparity assessments on health outcomes have been considered as critical determinants of health and health service outcomes. It is policy relevant in terms of the burden of disease and also provides focus on target interventions. This study aimed to assess the differences in the quality of Ante-natal Care (ANC) and the outcomes of Hypertensive Disorders in Pregnancy (HDPs) from selected health facilities in Ghana. This was a questionnaire-based cross-sectional study. Data on demographics, proportions of HDPs, quality of ANC and the outcomes of HDPs were collected. Logistic regression models were used to examine the association of the independent variables with the location of the health of facility. A total of 500 pregnant women were included in this study. There were 270 (54%) urban and 230 (46%) peri-urban dwellers. The proportion of HDPs varied with the location of the health facility. Women attending urban health facilities were more likely to be hypertensive (μ2 = 126.4; p<0.001), have chronic hypertension with superimposed pre-eclampsia (p< 0.001), have good quality ANC (μ2 = 41.28; p< 0.001), deliver full term (μ2 = 4.83; p = 0.028), and have excellent knowledge on HDPs (μ2 = 227.65; p< 0.001) compared to women receiving care in peri-urban health facilities. The method of delivery and outcome of birth did not statistically vary amongst the periurban and urban health facilities. There was an increase in the proportion in preterm in urban compared to periurban. The burden of HDPs was high in urban health facilities with high proportion of its mothers receiving quality ANC as well as having excellent knowledge on HDPs compared to mothers receiving care at the periurban health facilities. There is a need to target maternal care interventions to the periurban health facilities to improve obstetric health outcomes.

Uterine Artery Doppler Indices as Predictor of Adverse Fetal Outcome in Hypertensive Disorders of Pregnancy: An Observational Study.

Background Hypertensive disorders of pregnancy (HDP) pose significant risks to maternal and fetal health. The utility of Doppler indices in predicting adverse fetal outcomes in HDP patients remains an area of active research. This observational study aimed to assess the correlation between abnormal uterine artery Doppler indices and adverse fetal outcomes in HDP patients. Methods Over a two-year period, we enrolled 138 pregnant women with HDP beyond 28 weeks of gestation and singleton pregnancies. Detailed clinical assessments, laboratory investigations, and Doppler studies of the uterine artery were conducted. The Doppler indices that were assessed included the systolic/diastolic (S/D) ratio, resistance index (RI), and pulsatility index (PI). Adverse fetal outcomes were classified based on appearance, pulse, grimace, activity, and respiration (APGAR) scores, birth weight, NICU admissions, and perinatal deaths. Statistical analyses were performed to evaluate the predictive value of Doppler indices. Results Abnormal uterine artery Doppler indices, specifically an elevated S/D ratio and the presence of a diastolic notchshowed a positive correlation with adverse fetal outcomes. However, Doppler indices such as PI and RI did not demonstrate a significant correlation with adverse fetal outcomes in HDP patients. These findings suggest that the S/D ratio and the presence of a diastolic notch in uterine artery Doppler studies hold potential as predictive markers for adverse fetal outcomes in HDP patients. Conclusion Uterine artery Doppler indices, specifically the S/D ratio and the presence of a diastolic notch, appear to be valuable predictors for adverse fetal outcomes in patients with hypertensive disorders of pregnancy. These findings underscore the importance of regular monitoring of uterine artery Doppler flow in the management of HDP to identify pregnancies at higher risk for adverse fetal outcomes.

The Effect of SARS-CoV-2 İnfection on Perinatal Outcomes in Hypertensive Disorders of Pregnancy.

To evaluate the fetal and maternal effects of the severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection in women with hypertensive disorders of pregnancy. Patients with hypertensive disorders of pregnancy and SARS-CoV-2 polymerase chain reaction (PCR) positivity (n = 55) were compared with cases with similar characteristics and PCR negativity (n = 53). The study group was further divided into two groups as severe (n = 11) and nonsevere (n = 44) coronavirus disease 2019 (COVID-19). The groups were compared in terms of clinical characteristics and perinatal outcomes. The study and control groups were similar in terms of maternal age, parity, gestational age at diagnosis, type of hypertensive disorders, magnesium sulfate administration rate, gestational age at birth, birth weight, Apgar scores, and maternal complications. However, all cases of fetal loss (n = 6) were observed in the SARS-CoV-2 positive group (p = 0.027). From the 6 cases, there were 5 in the nonsevere group and 1 patient in the severe SARS-CoV-2 positive group. Moreover, higher rates of maternal complications, lower oxygen saturation values, and intensive care unit admissions were observed in the severe COVID-19 group. Physicians should be cautious about the management of hypertensive disorders of pregnancy cases with SARS-CoV-2 positivity. Fetal loss seems to be more common in cases with SARS-CoV-2 positivity and severe COVID-19 seems to be associated with higher rates of maternal complications. Close follow-up for fetal wellbeing and active management of severe cases in terms of maternal complications seem to be favorable.

Correlation of Uric Acid Levels with Feto-Maternal Outcomes in Hypertensive Disorders in Pregnancy

Objective: To explore the correlation between uric acid levels and feto-maternal outcomes in women with hypertensive disorders of pregnancy.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Obstetrics &amp; Gynaecology Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Aug 2021.&#x0D; Methodology: In this cross-sectional study, 90 pregnant women with hypertensive disorders having greater than 26 weeks of gestation were included after seeking Ethical Committee approval. Selected parameters were noted on a structured proforma.&#x0D; Results: Among the participants, 38(42.2%) had pregnancy-induced hypertension, 32(35.5%) had pre-eclampsia, 13(14.5%) had chronic hypertension with pre-eclampsia, and 7(7.8%) had eclampsia. Mean Uric acid levels ranged between 363.66±50.45 μmol/L and 451.86±120.62μmol/L, with a significant difference between PIH and eclampsia (p&lt;0.001). Mode of delivery was avaginal, primary cesarean section, and repeat cesarean section in 31(34.4%), 38(42.2%), and 21(23.4%) patients, respectively(p&lt;0.001). Liquor was meconium stained in 49(54.4%) while clear in 41(45.6%) births, with (p&lt;0.001). Early neonatal deaths6(6.7%) participants had significantly higher uric acid levels than no NICU admission 22(24.4%). In maternal outcomes, 83 patients (92.2%) required routine post-operative care, while 7(7.8 %) went to the intensive care unit. Uric acid levels had a negative correlation with gestational age.&#x0D; Conclusion: Maternal uric acid levels differ significantly in different hypertensive disorders of pregnancy and affect the mode of delivery and neonatal outcomes.

Effects of Vitamin E in Hypertensive Disorder of Pregnancy and Its Outcomes

Objective: To investigate the effects of vitamin E in Hypertensive Disorder of Pregnancy and the effects of vitamin E in Pregnancy Outcomes in Hypertensive Disorder of Pregnancy. Study Design: Prospective Cohort Study Materials and Method Data source: A total of 1910 pregnant women visited to the OPD and admitted in the Obstetrics and Gynecology Department of the First Affiliated Hospital of Dali University in Yunnan Province from June 2017 to May 2018 fulfilling the inclusion criteria were included in our study group. Case selection: All the pregnant women between the ages 23 to 35 years were included in the study and were divided into four groups: Normal pregnant group, gestational hypertension group, Pre-eclampsia group, and severe Pre-eclampsia group. Control group: Normal pregnant women were included in this group. Statistical Method: This study was performed prospectively and collected data were statistically analyzed using SPSS software (version 20.0) using independent t-test, Pearson Chi-square test, and one-way ANOVA test. The P values considered significant at value P&lt;0.05. The descriptive data were presented using frequency and percentage. Multivariate Logistic regression analysis was conducted to examine the effect of vitamin E in HDP and Pregnancy outcomes including PPH, HIE, Neonatal rescue and 1≤Apgar Score≤7. Results: 1. There was no statistically significant difference in the results of all studies on BMI, WOG in the third trimester, parity, and maternal age (P&gt;0.05). 2. Analysis between the effect of vitamin E and Hypertensive Disorder of Pregnancy: 2.1.1. There was no significant difference between the hypertensive group and control group during pregnancy in vitamin E level (t=1.665 P=0.096) (P&gt;0.05). 2.1.2. The difference between pre-eclampsia and severe pre-eclampsia group was statistically significant in vitamin E level (t=27.692 P=0.000) (P&lt;0.05). 2.2. Analysis between the effect of vitamin E levels and Hypertensive Disorders of pregnancy: 2.2.1. When vitamin E was excess, there was no significant difference between the control group, the gestational HTN group, pre-eclampsia group and severe pre-eclampsia group (X2 =0.164, P=0.983) (P&gt;0.05). 2.2.2. When vitamin E was deficient, the difference between the control group and the hypertensive group during pregnancy was statistically significant (X2 =20.580, P=0.00) (P &lt;0.05). 2.2.3. When vitamin E was deficient, there was no significant difference between the pre-eclampsia group and severe pre-eclampsia group (X2 =0.827, P=0.399) (P&gt;0.05). 3. Effects of vitamin E in Pregnancy Outcomes in Hypertensive Disorders of pregnancy: When vitamin E level was deficient ： In Gestational Hypertension group there is 8.3% occurrence of PPH, 8.3% newborn has HIE. In pre-eclampsia group, there is 10% occurrence of PPH, 5% newborn has HIE, 5% newborn needed neonatal rescue and 5% newborn has 1≤Apgar Score≤7. In severe pre-eclampsia groups there is 5.7% occurrence of PPH, 5.7% newborn has HIE, 5.7% newborn needed neonatal rescue and 2.9% newborn has 1≤Apgar Score≤7. (X2 =2.325, P=0.887) (P&gt; 0.05) There was no significant difference in the incidence of 1≤Apgar Score≤7 and Neonatal rescue between the pre-eclampsia and the severe pre-eclampsia. Conclusion: 1. Vitamin E contents are related to the hypertensive disorder of pregnancy. 2. Vitamin E deficiency is related to the occurrence of hypertensive disorders of pregnancy and has effects on maternal health and fetal outcomes. 3. Serum levels of vitamin E detection during pregnancy can help in the prediction of HOP; hence, it can help to reduce the risk of Pre-eclampsia.

Association of Umbilical Cord Serum Oxidative Stress Markers, ADMA and Adiponectin with Adverse Fetal Outcomes in Hypertensive Disorders of Pregnancy

Background: Limited studies are available on fetal oxidative stress and endothelial dysfunction and their association with adverse fetal outcomes in hypertensive disorders of pregnancy (HDP). Method: Umbilical cord blood samples were collected at delivery from 134 pregnant women with HDP and 59 controls. Markers of oxidative stress, endothelial dysfunction and inflammation and adipokines were analyzed. Results were correlated with adverse fetal outcomes. Results: Malondialdehyde, total antioxidant status(TAS), ADMA and hsCRP levels were increased in late and early onset preeclampsia. Adiponectin levels were decreased in early onset preeclampsia. High ADMA levels were positively associated with preterm births and fetal mortality and high TAS, protein carbonyl content(PC), ADMA and low adiponectin levels were positively associated with low birth weight babies. Conclusion: Fetal systemic oxidative stress, endothelial dysfunction and inflammation were altered in early and late onset preeclampsia. High TAS, PC and ADMA levels and low adiponectin levels were positively associated with adverse fetal outcomes in HDP.

Correlation of Maternal Serum Uric Acid Level and Feto-maternal Outcome in Hypertensive Disorder of Pregnancy: A Prospective Study

Introduction: Hypertensive disorder of pregnancy complicates around 5-10% of all pregnancies. Hyperuricemia is one of the common findings in pre-eclampsia. The uric acid level in pre-eclamptic women is increased before the onset of hypertension and proteinuria. The increase in serum uric acid is associated with an increased risk of adverse fetal outcomes like IUGR, prematurity, IUFD and increased severity of maternal hypertensive disorders like pre-eclampsia, severe pre-eclampsia, and eclampsia and HELLP syndrome.&#x0D; Methods: This was an observational, prospective cross-sectional study. One hundred and twenty women fulfilling the inclusion criteria were included in the study. Maternal uric acid was grouped into two groups i) &lt;5.5mg/dl and ii) ≥ 5.5 mg/dl. A Pearson’s Chi-Squared test was carried out to assess whether maternal serum uric acid level and maternal and fetal complications were related.&#x0D; Results: A total of 120 women fulfilling the inclusion criteria were included in the study. Seventy-six women (63.3%) had serum uric acid levels &lt;5.5mg/dl and forty-four (36.7%) women had serum uric acid levels≥ 5.5 mg/dl. In women with serum uric acid levels of 5.5 mg/dl and more, 21 fetuses with complications like IUFD, IUGR, prematurity and those whose serum uric acid level was less than 5.5 mg/dl, 16 fetuses had complications. There was a significant association between maternal serum uric acid levels and maternal complications like pre-eclampsia, severe pre-eclampsia, eclampsia and HELLP syndrome (p=0.004).&#x0D; Conclusion: Raised serum uric acid is associated with an increased risk of the feto-maternal outcome.

Maternal and Neonatal Outcomes in Hypertensive Disorders during Pregnancy

Context: Pregnancy is a physiological phenomenon, and each pregnancy is unique and valuable in its own way. Hypertensive diseases during pregnancy begin throughout pregnancy and disappear entirely after birth. Hypertensive disorders in pregnancy (HDP), including pregnancy-induced hypertension (HTN), chronic HTN (CHTN), (superimposed) preeclampsia, and eclampsia, are responsible for increased perinatal morbidity and mortality. Aim: The aim of this study was to investigate the prevalence and perinatal effects in women with hypertensive disease during pregnancy. Setting and Design: Hospital based cross section study was conducted on pregnant women. Methods and Materials: A hospital-based cross-sectional study was carried out from September 2019 to August 2021 on women whose pregnancies were complicated by HTN disorders. Mothers of the baby suffering from systemic diseases were excluded from the study. Statistical analysis used: Descriptive and inferential statistical analysis was conducted. Results: In the present study results the prevalence of gestational HTN at 8.49%, preeclampsia at 18.10%, severe preeclampsia at 8.75%, and CHTN was 2.28%. It was shown that the prevalence of hypertensive disease is 38%. A significant difference was found between the maternal age group of mothers suffering from HTN disorders during pregnancy with mean gestational age in weeks F = 124.6477, P = 0.0001 at a 5% level. Furthermore, a significant statistical difference was observed with different maternal age groups having different mean Apgar scores at 1 min with F = 81.0233, P = 0.0001. Conclusion: Prenatal HTN is one of the leading causes of maternal and neonatal death. Despite having all of the resources and several government programs in both urban and rural areas, many women suffer from HDP in both locations (rural and urban). Hence, management, as well as awareness among pregnant women regarding hypertensive diseases in pregnancy, is required.

Cerebroplacental Ratio Versus Nonstress Test in Predicting Adverse Perinatal Outcomes in Hypertensive Disorders of Pregnancy: A Prospective Observational Study.

Introduction: In developing countries, nonstress test (NST) is the most widely used method for antenatal fetal surveillance.Lately, cerebroplacental ratio (CPR) has emerged as a predictor for adverse perinatal outcomes, especially in hypertensive disorders in pregnancy (HDP). Against this background, the present study was conducted with the primary objective of quantifying the diagnostic accuracy of cerebroplacental ratio (CPR) versus nonstress test (NST) in predicting adverse perinatal outcomes in women with HDP.Methods: This was a prospective observational cohort study conducted in a tertiary care institute in eastern India. All consecutive women with hypertension in pregnancy at a gestational age of ≥32 weeks were recruited into the study. Both CPR and NST were performed at baseline and repeated weekly till delivery. The parameters obtained within one week of delivery were entered for analysis.Results: Sixty-two of the 65 women completed the study. There were 22 women (35.5%) in group A (both CPR and NST normal), 17 (27.4%) in group B (CPR abnormal, NST normal), 14 (22.6%) in group C (CPR normal and NST abnormal), and nine (14.5%) in group D (both CPR and NST abnormal). CPR had greater sensitivity (93.33% versus 46.67%), with higher positive predictive value (53.85% versus 30.43%), specificity (74.47% versus 65.91%), and negative predictive value (97.22% versus 79.49%) than NST for predicting neonatal intensive care unit admission. CPR also had higher sensitivity (84.62% versus 61.54%) and specificity (91.34% versus 69.39%) than NST in predicting neonatal complications. The negative predictive value (NPV) of CPR was 100% for predicting requirement of bag and mask ventilation and continuous positive airway pressure.Conclusion: CPR had greater diagnostic accuracy in terms of both higher sensitivity and greater specificity than NST in predicting adverse perinatal outcomes in women with hypertensive disorders of pregnancy.

Maternal Serum High-Sensitivity C-Reactive Protein (hsCRP) as a Prognostic Marker of Fetomaternal Outcome in Hypertensive Disorders of Pregnancy: A Novel Study.

Introduction: Hypertensive disorders of pregnancy (HDP) are a group of obstetric disorders causing profound fetomaternal compromise, leading to adverse obstetric outcomes. High-sensitivity c-reactive protein (hsCRP), an inflammatory marker of systemic inflammation, is elevated in HDP and correlates with the severity of the disease. However, prediction and prevention of HDP and its associated fetomaternal complications remain elusive to most obstetricians. The present study aimed to evaluate the use of hsCRP as a prognostic marker of adverse fetomaternal outcome in HDP.Methods: The study included 132 third-trimester pregnancies with HDP who underwent hsCRP quantification at the time of presentation to the out-patient department and followed up till delivery. HsCRP quantification was done using immunoturbidimetry method.Results: Of the 132 cases studied, 72 had normal hsCRP levels while the remaining 60 had raised hsCRP levels. It was observed that patients with raised hsCRP levels had poorer fetomaternal outcomes at delivery as compared to those with normal hsCRP levels. Conclusion: The obstetric outcomes of patients with HDP worsened with increasing levels of hsCRP, as shown in our study, when compared to normotensive patients. Thus, hsCRP delivers promising results as a prognostic marker of adverse fetomaternal outcomes in patients of HDP.

Neonatal outcome in hypertensive disorders of pregnancy in tertiary care centre

Hypertensive disorders of pregnancy, contribute to significant neonatal mortality and morbidity, with complications ranging from prematurity, low birth weight and respiratory morbidities.This study is a observational study done in tertiary care hospital in Cuttack, Odisha during the period December 2018 to November 2020. Mothers, aged 18 to 36 years, beyond 20 weeks of pregnancy with hypertensive disorders complicating pregnancy admitted, with booked pregnancy and regular antenatal check-up were included in the study. Those with underlying chronic diseases like chronic diabetes mellitus, chronic renal failure, chronic hypertension, heart disease, twin or multiple pregnancy and polyhydramnios were excluded. The neonates born followed and outcomes noted. Data analysed using SPSS 26 and results expressed in percentage and comparison across the groups done using Chi Square test / Fisher's Exact Test as appropriate.: Among 150 mothers, majority were suffering from severe preeclampsia (36%) followed by gestational hypertension (27.3%), with most (66.7%) being a term pregnancy. 20.9% were stillbirths and 34% needed NICU admission for various complications. The most common neonatal complication noted was intrauterine growth retardation. A significant association noted between the severity of hypertension and maturity (p&amp;#60;0.001), birth weight (p=0.001), delivery outcome (p=0.001) and neonatal complications (p=0.009). The delivery outcome, gestational age and birth weight, along with neonatal complications had a significant association with increasing severity of the hypertension. Thus, there is urgent necessity for strict protocols to screen, early detection and efficient management of these disorders in pregnant women, in order to ensure a safe outcome for both mother and newborn.

Role of Cerebro-Placental Ratio in prediction of adverse perinatal outcome in hypertensive disorder of pregnancy

Hypertensive disorder of pregnancy is a multisystem disorder associated with an increased risk of perinatal mortality worldwide. Doppler velocimetry of uterine, umbilical, and fetal vessels is an established method of antenatal monitoring identifying fetus at risk. The cerebroplacental ratio (CPR) is emerging as an important predictor of the adverse perinatal outcome as it considers both umbilical and middle cerebral artery doppler. The aim of this study is to find the role of CPR in the prediction of adverse perinatal outcome in the hypertensive disorder of pregnancy. A prospective descriptive study was done on women admitted to a tertiary care hospital in Kathmandu from July 2020 to June 2021 after taking ethical clearance from Institutional Review Committee. A total of 136 hypertensive pregnant women beyond 34 weeks of gestation underwent Doppler ultrasound, and CPR ratio &lt;1.08 (done within one week of delivery) was considered abnormal. During the study, CPR was normal in 101 women (74.3%) and was abnormal in 35 women (25.7%). The study showed that the rate of cesarean section was high in women with abnormal CPR than with normal CPR (77.1% vs 45.5%). The caesarean section done for fetal distress (70.4% vs 39.1%), Apgar score &lt; 7 in 5 minutes (14.3% vs 3.0%), NICU admission rate (54.3% vs 27.7%), and duration of NICU stay (3.9 + 4.08 vs 0.79 +1.94 days) were high in women with abnormal CPR. The cerebroplacental ratio in hypertension in pregnancy can provide useful information regarding fetal well-being and help us in improving fetal outcomes.