Pregnancy Induced Hypertension and Feto-Maternal Outcome in a Tertiary Care Hospital in Eastern India: A Prospective Study

Abstract

Introduction: Pregnancy Induced Hypertension (PIH) is known for its maternal and perinatal complications. Aim: To assess incidence of PIH and eclampsia in a tertiary care hospital and maternal and perinatal complications associated with it. Materials and Methods: This is a prospective observational study conducted in the department of obstetrics and gynaecology of Institute of Medical Sciences (IMS) and SUM hospital, Siksha O Anusandhan (SOA) University from July 2015 to December 2017. All deliveries during this period were analysed for incidence of PIH, all PIH cases were analysed for maternal and foetal outcome. All cases delivered during the study period, were diagnosed to have PIH when systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg measured on two occasions 4-6 hours apart beyond 20 weeks of pregnancy. Early onset PIH is defined as; when cases diagnosed before 34 weeks. PIH cases with convulsion were defined as eclampsia. All cases of chronic hypertension due to essential hypertension, chronic renal disease, connective tissue disorder were excluded. Maternal complications studied were cases of HELLP syndrome, Abruptio placentae, PPH, neurological complications, ICU admissions and maternal death. Perinatal complications expressed in terms of stillbirth, NICU admission and incidence of low birth weight. Statistical analysis was done with SPSS version 20.0 software using Yate’s corrected chi-square test and unpaired t-test. Results: Out of 5139 pregnancies 338 (6.57%) had PIH, 40 (0.77%) had eclampsia. PIH is more prevalent in primigravidas (67.4%). Eclampsia is prevalent in adolescents, as age advances incidence of eclampsia reduces and preeclampsia increases, and in elderly, preeclampsia is predominant, proved by unpaired t-test (p=0.003). Late onset preeclampsia is common in our population (93.5%) and 68.1% were term pregnancies. Maternal complication was present in 22/338 (6.5%) cases. It was significantly higher in early onset disease (p=0.001). LSCS rate (p=0.00891) and stillbirth (p<0.001) were significantly higher than general population. NICU admission and low birth weight incidence were also increased. Conclusion: Pregnancy induced hypertension still remains an important cause of maternal and perinatal morbidity and mortality. Late onset PIH is common in our population. Maternal complications are significantly higher in early onset disease than late onset disease. Early detection by proper antenatal care and timely proper intervention can reduce the complications. Adolescent primigravidas are more prone for eclampsia, the severe form of disease. Avoiding early marriage and explaining need of contraception to this group can reduce adolescent pregnancies and its dreaded complications.

Keywords

• diastolic and systolic blood pressure
• eclampsia
• neonatal intensive care unit
• perinatal
• stillbirth