Maternal and Perinatal Outcome Associated With Gestational Hypertension (original) (raw)
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IOSR Journals , 2019
Back Ground: Aim: The Aim of the study was to find out the incidence of PIH & Preeclampsia and to evaluate the risk factors, predictors of severity and obstetrical and perinatal outcome in severe preeclampsia and Eclampsia.. Place and duration Methodology: Out of total 8800 deliveries 880 were diagnosed to have pregnancy induced hypertension. Out of these 580 (66%) had gestational hypertension. 80(0.9%) cases had preeclampsia without severe features, 220(2.5%) cases had preeclampsia with severe features. The present study was conducted in 200 cases of preeclampsia with severe features. The cases were evaluated and managed as per the existing protocol in the department and Obstetrical and perinatal outcome were recorded and analyzed. Results: The incidence of pregnancy induced hypertension was 10% and preeclampsia 3.5% in our study. 50% had anemia and 30% had obesity as risk factors. Materanl mortality was seen in 12cases of severe preeclamsia, accounting to 50% of total maternal deaths in our centre. Other maternal complications were seen in 60% of cases.Most common was Eclamsia in 30% of cases followed by Abruption in 20% & DIC in 18% and 20% of cases required transfusion of blood & Blood components for thrombocytopenia and coagulation failure. 10% cases required ventilator support for dyspneoa. Perinatal mortality was seen in 16% of cases. Perinatal morality is due to premaurity, low birth weight and abruption. NICU admissions were required in 20% of cases because of severe birth Asphyxia. Conclusion: Regular antenatal checkup and regular blood pressure measurement will help in early detection of hypertensive cases. Treating anemia and educating women on significance of alarming symptoms will improve maternal and perinatal outcome. Hospitalisation, regular BP monitoring, investigations and timely delivery will improve significantly the maternal and perinatal outcome. A good maternal intensive care unit and neonatal intensive care unit will help to improve obstetrical and perinatal outcome in hypertensive disorders of pregnancy.
A study of maternal morbidity and mortality DUE to Pre eclampsia and eclampsia
Journal of the Medical Sciences, 2017
Background: Pre eclampsia and eclampsia is one of the leading causes of maternal morbidity and mortality worldwide. Eclampsia though still remains an obstetric enigma, and is a major problem in developing countries. Although the incidence of pre eclampsia and eclampsia is on the decline, still it remains major contributor to poor maternal outcome. In India-gestational hypertension continues to be responsible for the largest proportion of cases contributing to maternal morbidity and mortality. Aims & objectives: The main objective of the study is to analyse the case of pre eclampsia and eclampsia complicating pregnancy, its maternal outcome, study the consequences of hypertensive disorders contributing pregnancy and its management. Methods: All patients beyond 20 wks of pregnancy with hypertensive disorders complicating pregnancy admitted in Al Ameen Medical College Hospital, Bijapur during the two year three months study period were enrolled in the study. Results: Total hypertensive...
Pre-Eclampsia-Pregnancy Induced Hypertension; Threats and Consequences
INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH (IJEHSR), 2014
Pre-eclampsia is the elevated blood pressure and excess protein in the urine after 20 weeks of pregnancy in a woman who previously had normal blood pressure, a major cause of preterm birth and an early marker for future cardiovascular and metabolic diseases. The objective of study is to identify the level of awareness regarding pre-eclampsia (pregnancy induced hypertension or gestational hypertension) and its relation with increasing maternal and fetal mortality rate. The questionnaire based survey was conducted including both close & open ended questions and compared with the retrospective data among 160 respondents, in which our target was to investigate women of varying socioeconomic status & the duration of our research is almost 20 days. Statistically we found an overall poor awareness of pre-eclampsia with 26% of women surveyed having heard of it and remaining 74% were unknown to pre-eclampsia, 39% faced pre-eclampsia with its severe consequences and fetal mortality rate data showed 42% deaths stating pre-eclampsia as the major cause of it, in addition to that higher rate of maternal death i.e. 57% occurs due to pre-eclampsia subsiding other reasons as key reasons of maternal mortality. Hence it is concluded that Pre-eclampsia is a disorder of pregnancy with unknown etiology so awareness level is too low to decrease its incident & this lack of awareness translates to worse health outcomes proving pre-eclampsia as a major cause of maternal and fetal mortality and its lack of awareness increasing this risk day by day and making it a hidden threat to pregnancy.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2020
Background: Vascular-renal syndrome, also known as pre-eclampsia, is a condition specific to pregnancy, usually occurring in the last trimester of pregnancy. Pregnant women are sometimes at risk of unpredictable obstetrical complications such as: hemorrhage, kidney failure, HELLP syndrome, sometimes even brain damage requiring prompt care and multidisciplinary collaboration. Vascular-renal syndromes are the third leading cause of maternal death and also the world's leading cause of perinatal death. Objectives of this study were to analyse the management of vascular-renal syndromes. Calculate their frequency, describe the sociodemographic characteristics of patients, describe the clinical and biological signs of patients, evaluate the maternal-fetal prognosis.Methods: The study was conducted in the department of obstetrics and gynecology of Donka National Hospital. It was a prospective, descriptive, cross-sectional, 6-month study from March 1st to August 31st, 2015, of pregnant w...
Severe preeclampsia and eclampsia: adverse obstetric outcomes and prognostic factors
2021
Background: Hypertensive disorders of pregnancy are globally a threat to maternal and fetal outcomes. Despite massive efforts worldwide, these disorders continue to be a major adverse influence on the health goals especially in developing countries. The aim of the study was to measure the impact of hypertensive disorders of pregnancy in its most severe form on maternal and fetal outcomes in our region along with the important prognostic factors. The objective of this study was to investigate the maternal and fetal outcome in cases of severe preeclampsia and to evaluate the risk factors and complications associated with adverse outcomes.Methods: Indoor records of pregnant females at more than 20 weeks gestation with preeclampsia with severe features (as defined by the ACOG practice bulletin 222) and eclampsia admitted over a period of one year in a unit of obstetrics at Government Medical College, Amritsar were studied and results were statistically analysed.Results: The incidence of...
A STUDY OF MATERNAL OUTCOME IN SEVERE PRE-ECLAMPSIA
International Journal of Advanced Research (IJAR), 2024
Background&MaterialsandMethods:Pre-eclampsiaisapregnancy-induced hypertensive disorder seen after 20 weeks of gestation with multi-systeminvolvement.Inhealthynulliparouswomen,theprevalenceofpreeclampsia ranges between 2% and 7%. It is a major cause of maternal morbidity and mortality in healthy nulliparous women.Itis amultisystemdisorderthatleadstocertaincomplicationslikeplacentalabruption,HELLPsyndrome,eclampsia,DIC,pulmonaryedema,adultrespiratory distress syndrome (ARDS), and acute renal failure leading to highmaternal morbidity and mortality. The aim of the study is to evaluate the maternaloutcomein severe preeclampsia. Cases with severe preeclampsia (B.P readingof 160/110mmHgwith1+ormorealbuminuria)after 28weeksof gestational age were included in the study and followed upto 6weeks postpartum.Atotal number of 100 cases were included in the study. Study variables were modeofdelivery,maternalmorbidity-mortality. Result: This study analyzed 100 patients with severe preeclampsia.Out of the 100 patients in the present study, maximum (43.0%) cases were inthe agegroupof 21to 25years,most (62.0%) of them were primigravida,and most of the cases were < 34 weeks of pregnancy. Inourstudy,themostcommonmodeofdelivery(61.0%) was cesarean delivery. (39.0%) of patients delivered vaginally. Outof all normal deliveries, (29.0%) of patients delivered spontaneously, around(9.0%) of all deliveries are preceded by labor induction, and (1.0%) ofpatients needed vacuum delivery during the secondstage of labor. The most common maternal complication in the present studywas abruption (10.0%), followed by oligohydramnios (9.0%) and PPH(6.0%),HELLP(6.0%),eclampsia (4.0%), posterior reversible encephalopathy syndrome (PRES-3.0%), PPCM (2.0%), multiple organ dysfunction syndrome (2.0%), pulmonaryedema(1.0%) andDIC (1.0%). In ourstudyabruptio placenta was the most common one. Conclusion:Preeclampsia continues to be a significant cause of maternal morbidity and mortality. Regular antenatal check-ups are very important to emphasizeearlywarningsymptoms&signssothatlife-threateningcomplications can beprevented.Provision ofqualitymaternalhealth careservices,increasingpatientawarenessaboutvariouswarningsymptoms, investigations, timely referral of patients to higher centers, the timely use ofantihypertensivedrugs,timelydelivery&intensivemonitoringintheintrapartum &postpartum period can result in improvement in maternaloutcome.
Pre-eclampsia and the hypertensive disorders of pregnancy
British Medical Bulletin, 2003
Pre-eclampsia is a multisystem disorder, of unknown aetiology, usually associated with raised blood pressure and proteinuria. Although outcome for most women and their babies is good, it remains a major cause of morbidity and mortality. A wide range of interventions for prevention and treatment of pre-eclampsia have been evaluated in randomized trials. This evidence provides the basis for a rational approach to care. Overall, there is insufficient evidence for any firm conclusion about the effects of any aspect of diet or lifestyle during pregnancy. Antiplatelet agents are associated with a 19% reduction in the risk of pre-eclampsia (relative risk 0.81; 95% CI 0.75, 0.88), a 7% reduction in the risk of preterm birth (RR 0.93; 95% CI 0.89, 0.98), a 16% reduction in the risk of stillbirth or neonatal death (RR 0.84; 95% CI 0.74, 0.96) and an 8% reduction in the risk of a small for gestational age baby (RR 0.92; 95% CI 0.85, 1.00). For mild to moderate hypertension, trials evaluating bed rest are too small for reliable conclusions about the potential benefits and hazards. Antihypertensive agents halve the risk of progression to severe hypertension (RR 0.52; 95% CI 0.41, 0.64), but with no clear effect on pre-eclampsia (RR 0.99; 95% CI 0.84, 1.18), or any other substantive outcome. For severe hypertension, there is no good evidence that one drug is any better than another. Plasma volume expansion for severe pre-eclampsia seems unlikely to be beneficial, although the trials are small. The optimum timing of delivery for pre-eclampsia before 34 weeks is unclear. Magnesium sulphate more than halves the risk of eclampsia (RR 0.41; 95% CI 0.29, 0.58) and probably reduces the risk of maternal death (RR 0.54; 95% CI 0.26, 1.10). It is also the drug of choice for treatment of eclampsia.
Research Square (Research Square), 2023
Introduction: Pre-eclampsia (PE) is a multi-system hypertensive condition characterized by a blood pressure of greater than 140/90 mmHg recorded on two separate readings at least 4 hours apart and associated with proteinuria or end organ dysfunction. It is called Eclampsia when a patient with preeclampsia develops tonic-clonic seizures as well. It is thought to occur due to disordered trophoblastic invasion that causes uteroplacental hypoperfusion, leading to widespread endothelial dysfunction. Risk factors include PE in a previous pregnancy, Chronic kidney disease, diabetes mellitus, chronic hypertension or autoimmune diseases. Increased maternal age, high BMI and family history also play a role in its pathology. Pakistan has the third highest maternal mortality according to a recent global health analysis, 29% of this is contributed by hypertensive disorders. This study aims to study the predisposing risk factors in pre-eclampsia patients at a tertiary care hospital. Methods: 82 selected cases of pre-eclampsia and eclampsia were included in this cross-sectional study. Informed consent was taken from all the patients and a pre-tested questionnaire was lled out by interviewing them during their antenatal visits. Results: Most (61%) of the patients were in the third decade (20-29) of their life. The mean of the blood pressure checked at the time of interviewing was 153/95 mmHg. The majority (54.90%) of the patients were overweight (BMI=26-34.9). The most commonly identi ed risk factors include; raised diastolic BP at the booking visit (60%), history of pre-eclampsia in a previous pregnancy (41%), nulliparity (37%), obesity (37%) family history of pre-eclampsia (28%), GDM (21%) and chronic HTN (13%). Other less common risk factors include severe anemia (9%), a gap of more than 10 years (7%), multiple gestations (5%) and maternal age of more than 35 years (4%). Conclusion: Pre-eclampsia is a signi cant threat to maternal as well as fetal life. And it has a higher incidence in the developing part of the world. Various risk factors are attributed to its pathophysiology. Prompt diagnosis and proper management and monitoring can reduce the morbidity and mortality associated with pre-eclampsia.
A Study of Maternal Deaths from Pre Eclampsia and Eclampsia in a Tertiary Care Centre
IOSR Journals , 2019
Background: Pre eclampsia and eclampsia is one of the leading cause of maternal morbidity and mortality worldwide. Eclampsia though still remains an obstetric enigma and is a major problem in developing countries. Predicting the onset of these complications could aid in timely intervention such as increased surveillance, treatment of symptoms, transfer to higher care facility and delivery when necessary which could reduce morbidity and mortality from the hypertensive disorders of pregnancy. AIM: The aim of this study is to calculate the total number of women admitted with hypertensive disorders of pregnancy and eclampsia in the labour room and their case fatality rate and to calculate the number of mothers who died from pre eclampsia and eclampsia and to analyse all the maternal deaths due to hypertensive disorders of pregnancy in order to identify the root causes of substandard care leading to maternal deaths. MATERIALS AND METHODS: This study was carried out at GMKMCH ,Salem for a period of 2 years from January 2016-December 2017. All the mothers who died from severe pre eclampsia and eclampsia were included in this study and they were all analysed. RESULT: In 2 years study period, there were 1551 women admitted with hypertensive disorders of pregnancy and 341 women admitted with eclampsia giving a prevalence rate of 9.28% and 2.04% respectively. Case fatality rate of Hypertensive disorders of pregnancy was 1.61 %. During the study period , there were total 84 maternal Deaths. Out of 84 maternal deaths , 25 were due to severe pre eclampsia and eclampsia making it the leading cause of maternal mortality in our institute. CONCLUSION: Pre eclampsia and eclampsia is one of the leading causes of maternal mortality and morbidity. Though the incidence of pre eclampsia and eclampsia is on the decline, still it remains the main contributor to poor maternal and fetal outcome, Regular antenatal checkups, early diagnosis, use of anti-hypertensive drugs, optimal timing of delivery and strict fluid balance, anti-convulsants in case of eclampsia will help to achieve successful outcome.