Hypertension in Pregnancy Still Remains a Serious Complication Causing Severe Morbidity and Mortality of Mother (original) (raw)
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International journal of reproduction, contraception, obstetrics and gynecology, 2023
Pregnancy and childbirth are natural processes, which comes up with multiple consequences. A hypertensive disorder is one of the pregnancy consequences which is a major alarming cause for maternal, perinatal morbidity and mortalities. The term hypertension in pregnancy is commonly used to describe a wide spectrum of the patient who may have only mild elevations in blood pressure to severe organ dysfunction. Thus, it is accompanied by minor to major complications. Worldwide hypertensive disorder in pregnancy/HDP affects 5-22% and it is responsible for 5-10% of complications in all pregnancies. PIH denotes women's systolic blood pressure/SBP ≥140mmHg, and diastolic blood pressure/DBP ≥90mmHg
BackgroundHypertensive disorders of pregnancy are one of the important causes for adverse maternal and fetal outcome. A proper understanding of this medical disorder in pregnancy is essential to reduce the complications associated with it.ObjectiveTo analyze the maternal and perinatal outcome in hypertensive disordercomplicating pregnancy.Materials & Methods:It is a prospective, observational study of 180 pregnant women with hypertensive disorders of pregnancy admitted to GVH from November 2016 to October 2017. Data was collected regarding antenatal care-booked and unbooked cases, age, parity, gestational age, mode of delivery and maternal complications.Perinatal outcome including birth weight, NICU admissions and perinatal deaths was recorded. Data was analysed and tabulated using SPSS version 24.Results:The total number of deliveries during this period was 7,422 and 180 women had hypertension complicating pregnancy giving an incidence of 2.4%.Normal vaginal delivery was seen in 90 cases (50%) and instrumental delivery in 18 cases (10%). The caesarian section rate was 40%. The number of cases with pulmonary edema was 2 (1.1%), HELLP was 5 cases (2.7%) and abruption was 6 cases (3.3%). DIC was seen in 2 cases (1.1%), renal failure in 1 case (0.5%) and PPH in 11 cases (6.1%) and in 1 case (0.5%) thromboembolism was seen. There were 2 maternal deaths, one with DIC and one with thromboembolism. The number of stillbirths was 20 (11.11%) and growth retardation was 27 cases (15%). The number of cases with birth weight less than 2.5 kg was 39 (21.66%). NICU admission was required for 42 babies (23.33%). Early neonatal deaths occurred in 4 cases (2.2%). The perinatal death rate was 13.3 %.Conclusion:Hypertension in pregnancy is associated with adverse maternal and perinatal outcome. Good antenatal care and early referral can reduce complications.
Frequency of maternal mortality and morbidity in pregnancy-induced hypertension
Journal of Ayub Medical College, Abbottabad : JAMC
Pregnancy-induced hypertension (PIH) is defines as hypertension in pregnancy, and is sustained blood pressure >140 mm Hg systolic or 90 mm Hg diastolic. Objective of this study was to see the maternal outcome in terms of morbidity and mortality in PIH. This descriptive study was conducted in Obstetrics and Gynaecology Unit of Fauji Foundation Hospital, Rawalpindi from January to December 2010. Both booked and un-booked cases were selected after fulfilling inclusion criteria. A detailed history and clinical examination was recorded and relevant investigations were performed. Patients were monitored for rise in blood pressure, development of complications related to hypertensions in pregnancy as well as maternal and perinatal outcome. During this period, 100 patients were admitted with pregnancy-induced hypertension. Majority were un-booked. Primigravida were 60 (60%), and were in age group 21-30 year, remaining were above 30 year. Four patients had placental abruption, 2 pulmonary...
Bjog: An International Journal Of Obstetrics And Gynaecology, 2018
Objective To investigate life-threatening maternal complications related to hypertensive disorders of pregnancy (HDP) in Nigerian public tertiary hospitals. Design Secondary analysis of a nationwide cross-sectional study. Setting Forty-two tertiary hospitals. Population Women admitted for pregnancy, childbirth or puerperal complications. Method All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to HDP were prospectively identified using the WHO criteria over a 1-year period. Main outcome measures Incidence of SMO, health service events, case fatality rate, and mortality index (% of maternal death/ SMO). Results Out of 100 107 admissions for maternal complications, 6753 (6.8%) women had HDP. Pre-eclampsia (PE) (54.5%) and eclampsia (E) (30.4%) were the most common HDP recorded. SMO occurred in 587 women with HDP: 298 maternal nearmisses and 289 maternal deaths. The majority (93%) of the women with SMO due to HDP were admitted in a critical condition. The median diagnosis-definitive intervention interval was over 4 hours in a quarter of women who died from HDP. For PE and E, case fatality rates were 1.9 and 10.4%, respectively, although both conditions had a similar mortality index of 49.3%. Lack of antenatal care and place of residence further than 5 km from the hospital were associated with maternal death. Conclusions Severe maternal outcomes from HDP were due to late presentations and health system challenges. To reduce maternal deaths from HDP, health system strengthening that would engender early hospital presentation and prompt treatment is recommended. Funding The original research that generated the data for this secondary analysis was funded by the UNDP/UNFPA/UNICEF/ WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO). We have no other funding issue to declare for our study.
Maternal and Perinatal Outcome in Hypertensive Disorders of Pregnancy - A Retrospective Study
MVP Journal of Medical Sciences, 2018
Background: It was a retrospective observational study to know demographic factors, maternal and perinatal outcome in patients of hypertensive disorders of pregnancy admitted in a medical college and tertiary health care center. Introduction: Hypertensive disorders of pregnancy are one of the important cause of maternal morbidity and mortality in India. Hypertensive Disorders of Pregnancy (HDP) account for nearly 18% of all maternal deaths worldwide. Delivery at early gestational age in patients of HDP is associated with high perinatal morbidity and mortality resulting from prematurity. Method: Total number of 120 cases of hypertensive disorders of pregnancy admitted in our hospital was included in the study after satisfying inclusion and exclusion criteria. We studied demographic factors as well as maternal and perinatal outcome. Results: Majority of the patients i.e. 40% were in the age group of 21-30 yrs. 61% of patients were primi gravida and 25% of patients were second gravida. Maximum number of patients had gestational age ≥ 32weeks at the time of delivery. 26.6% patients, 73.4% patient's and 12.5% patients were diagnosed as gestational hypertension, preeclampsia and eclampsia respectively. There was high incidence of HELLP and eclampsia in 12.5% each, DIC in (5%), APH in (4.1%), renal complications in (3.3%) and CNS complication were seen in 0.8%. 67.5% patients were delivered by vaginal route, 32.50% patients required LSCS. Majority of patients i.e., 60% underwent preterm delivery, 34% delivered at term. Maternal mortality occurred in 8 patients (6.67%). HELLP and DIC were the leading causes of death. 70% patients had good perinatal outcome. There were 25.83% still births and 4.17% neonatal deaths. Conclusion: Hypertensive disorders of pregnancy are associated with increased maternal and perinatal morbidity and mortality. Good antenatal care, health education, early diagnosis, early referral to higher center and multidisciplinary approach will reduce morbidity and mortality in mother and baby.
Factors Affecting with the Prevalence of Hypertension in Pregnancy: Scoping Review
PLACENTUM: Jurnal Ilmiah Kesehatan dan Aplikasinya, 2022
Background: Hypertension is a clinical term to describe the pressure of high blood which cause fetal morbidity due to reduced blood flow to the placenta, such as stunted fetal growth, fetal death in utero to premature birth to cause maternal morbidity such as pulmonary edema, bleeding in the brain, eclamptic seizures, blood clots in the veins, acute kidney failure and even death in the mother. Hypertension in Pregnancy is a major complication that causes 60% to 80% of maternal deaths and maternal morbidity in the worldwide. The purpose of this scoping review is to determine the factors that influence the incidence of hypertension in pregnancy.Method: Scoping Review uses the following databases: Pubmed, Wiley Online Library, and ProQuest. Search results that meet the criteria will then be parsed into articles. Study Use of the Joana Briggs Institute/JBI and synthetic methods using transforming PEOS.Results: From the 108 articles related to the title and abstract, 9 articles met the i...
CLINICAL PRACTICE 78 Management of Hypertension in Pregnancy
ABSTRAK Mortalitas maternal akibat hipertensi mencapai 16% bila dibandingkan dengan penyebab lain seperti sepsis, perdarahan maupun abortus. Ibu hamil dengan hipertensi berpotensi mengalami sejumlah komplikasi antara lain koagulasi intravaskular diseminata (KID), perdarahan otak, gangguan fungsi hati, dan gagal ginjal akut. Sedangkan pada janin dapat berakibat pertumbuhan janin terhambat, prematuritas dan mortalitas perinatal. Hipertensi pada kehamilan perlu ditatalaksana dengan baik agar dapat menurunkan angka morbiditas serta mortalitas ibu dan janin, yaitu dengan menghindarkan ibu dari resiko peningkatan tekanan darah, mencegah perkembangan penyakit dan mencegah timbulnya kejang dan pertimbangan terminasi kehamilan jika ibu atau janin dalam keadaan bahaya. ABSTRACT Hypertension-related maternal mortality reaches 16% when it is compared to other causes of maternal mortality such as sepsis, bleeding or abortus. Pregnant women with hypertension disorder are at increased risk for exp...
Pregnancy outcome and maternal complications in women with chronic hypertension
Aim: To evaluate the pregnancy outcome and maternal complications in 166 pregnant women with chronic hypertension. A correlation between specific clinical features and various risk factors was made. Methods: Onehundredsixtysix pregnant women with hypertension in pharmacological treatment before pregnancy or evidence of hypertension that needed a pharmacological treatment before the 20 th week of gestation in the actual pregnancy were evaluated. Results: Fifteen patients (9%) developed preeclampsia. Thirteen deliveries (7%) were induced because of a significative rise in blood pressure and 5 women (3%) had placental abruptio. Twentyfour infants (14.6%) were LBW, 13 were VLBW (7.9%) and 35 (21%) were SGA, but only 8 (5%) showed a growth restriction in utero. A statistically significant correlation between the systolic blood pressure at the first control and IUGR (1% if PAS<140mmHg vs. 9% if PAS>140mmHg), between abnormal uterine artery Doppler velocimetry and development of superimposed PE (37% if abnormal vs. 5% if normal), IUGR (16% if abnormal vs. 1% if normal) and LBW (63% if abnormal vs. 13% if normal) was found. Other maternal factors (age, geographical origin, presence or absence of kidney diseases, smoking and an abnormal fundus oculi) were not correlated with maternal and fetal complications. Conclusions: In pregnant women with chronic hypertension, the incidence of maternal and fetal complications was found to be higher than in the general population, but lower than that reported in the literature. A systolic blood pressure higher than 140mmHg at the first control was correlated with an increased incidence IUGR.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Pregnancy induced hypertension is one of the major causes of feto maternal morbidity and mortality in pregnancy. The exact cause of PIH is unknown certain factors are known to increase the risk of PIH such as risk factor includes that young women with first pregnancy.Methods: The objective of this study was to assess the socio-demographic and clinico-pathological profile of the patients with hypertensive disorders of pregnancy and its associated fetal outcomes. A prospective study was conducted in department of obstetrics and gynecology Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura Karnataka from 15th July to 15th December 2018. All women admitted to labour ward with diagnosis of hypertensive disorders of pregnancy were included in the study after ruling out the exclusion criteria and thorough history, examination and laboratory evaluation were done and followed till delivery.Results: A total of 123 pregnant wo...