Maternal and Fetal Outcome of Pregnancies Complicated with Hypertension in a Tertiary Care Hospital in Eastern Nepal

Abstract

A cross sectional study was conducted between March 2011 and August 2011 at B. P. Koirala Institute of Health Sciences (BPKIHS). All women delivering at BPKIHS whose pregnancies were complicated by hypertensive disorders were identified. Their demographic profile including age, parity, clinical presentation, laboratory investigations, mode of delivery, requirement of  drug  therapy, maternal complications, birth  outcome  and  blood pressure  at  discharge  was  noted. The patients were followed up over the next 6 months for their delivery in the hospital and their outcomes ascertained. Objectives: To study maternal and fetal morbidities and mortality in patients with hypertensive disorders in pregnancy. Study Design: Descriptive cross sectional study. Place and Duration of Study: Department of Obstetrics and Gynecology, B. P. Koirala institute of health sciences (BPKIHS) between March 2011 to August 2011. Materials and Methods: All pregnant patients with hypertension admitted during the study period were enrolled in the study and followed up till delivery. Clinical and laboratory parameters were used to stratify the type of hypertension. Maternal outcome identified were pulmonary edema, acute renal failure, HELLP(hemolysis, elevated liver enzymes, low platelet), ascites, DIC(disseminated intravascular coagulation),seizures, PPH(postpartum hemorrhage), abruptio and death. Fetal outcomes studied were birth weight, presence of IUGR, 5min Apgar score, ante or intrapartum death and admission to ICU or neonatal ward. Results: 2.4% of total deliveries were complicated by hypertension. There were 36.5% of patients with non-severe /mild preeclampsia, 53.1% severe preeclampsia and 10.4% gestational hypertension. It was seen that 45% of the patients needed induction of labour. 46.9% of patients delivered vaginally while 44.8% underwent cesarean section. The maternal complications found were as follows: 21.9% patients had ascites, 15.6% seizures, 13.5% postpartum hemorrhage, 7.3% abruption, 4.2% each had acute renal failure and acute pulmonary edema, 2.1% HELLP syndrome and 1% DIC. There was significant association between the complications like ascites, postpartum hemorrhage seizures and abruption and the severity of hypertension. Among the total deliveries, 40.6% were preterm and 50% were low birth weight. 21.9% were small for gestational age. The 5 minute Apgar score was more than 7 for 77.9% of the babies.11.5% babies had ante/intrapartum death. 4.8% of the babies were admitted in the intensive care unit and 23.1% were admitted in the pediatric ward. Conclusion: Hypertensive disorders in pregnancy are associated with significant maternal and fetal morbidity and mortality and hence deserve due concern in obstetric practice.