Maternal and perinatal outcome in pregnancies complicated with hypertensive disorder of pregnancy: a seven year experience of a tertiary care center

Department of Obstetrics and Gynecology, School of Medicine, University of Kocaeli, Kocaeli, Turkey.
Archives of Gynecology and Obstetrics (Impact Factor: 1.36). 12/2005; 273(1):43-9. DOI: 10.1007/s00404-005-0741-3
Source: PubMed

ABSTRACT The aim of the study was to determine the risk factors, prevalance, epidemiological parameters and maternal-perinatal outcome in pregnant women with hypertensive disorder.
A retrospective analysis was undertaken on 255 consecutive cases of hypertensive disorder in pregnancy who were managed at Kocaeli University, School of Medicine, Department of Obstetrics and Gynecology from June 1997 to November 2004. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally delivery route, indications of cesarean section, fetal and maternal complications were determined. Statistical analysis was performed by SPSS programme using Kruskal Wallis nonparametric test, ANOVA (Analysis of variance) and chi-square tests.
Of 5,155 deliveries in our clinic during the defined period, 438 cases (8.49%) were managed as hypertensive disorder of pregnancy. Medical records of 255 cases could be avaliable. Of 255 cases, 138 patients (54.11%) were found to have severe preeclampsia while 88 cases (34.50%) were diagnosed as mild preeclampsia. Twenty-nine patients (11.37%) were suffering from chronic hypertension. Of 138 severely preeclamptic cases, 28 cases (11%) had eclamptic convulsion and another 28 patients (11%) were demonstrated to have HELLP syndrome. Intrauterine growth restriction, oligohydramnios, placental ablation were the obstetric complications in 75 (29.4%), 49 (19.2%), 19 (7.5%) cases, respectively. Additionally multiple pregnancy and gestational diabetes mellitus were noted in 5.9% (n:15) and 3.9% (n:10) of the patients. Delivery route was vaginal in 105 patients (41.2%) while 150 patients (58.8%) underwent cesarean section with the most frequent indication to be fetal distress in 69 cases (46%). Cesarean section rate seemed to be the lowest (48.3%) in chronic hypertensive women while the highest (63.8%) in severe preeclamptic patients. Maternal mortality occured in 3 cases (1.2%) and all of those cases were complicated with HELLP syndrome. Intracranial bleeding was the cause of maternal death in one case while the other two cases were lost due to acute renal failure and disseminated intravascular coagulation, respectively. Intrauterine fetal demise was recorded in 24 cases on admission. Ten fetuses died during the intrapartum period. Mean gestational age and birth weight were 28 +/- 3.5 and 1000 +/- 416 g, respectively in this group. In these ten women, five cases were diagnosed as HELLP syndrome, two were severely preeclamptic and three were eclamptic. Perinatal mortality rate was found to be 144/1,000 births
Hypertensive disorder of pregnancy is associated with increased risk of maternal-perinatal adverse outcome. The complications of severe preeclampsia and eclampsia could be prevented by more widespread use of prenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.

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    • "The present study has also shown that patients with pre-eclampsia are more likely to develop disseminated intravascular coagulation than are those with other hypertensive disorders. The recorded occurrence of disseminated intravascular coagulation (1.9%) is lower than the frequency of 2.35% reported by Yücesoy et al. [21], but substantially higher than the rate of 0.5% determined by Buga et al. [11]. These variations could be due to different diagnostic criteria used on the basis of the availability of laboratory support. "
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    ABSTRACT: Objective To determine maternal outcomes of hypertensive disorders in pregnancy at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Methods A cross-sectional study was conducted between January 1 and February 28, 2013. All women delivering at KBTH whose pregnancies were complicated by hypertensive disorders were identified. A structured questionnaire was administered, and the women were followed up on a daily basis until discharge from hospital. Medical records were also reviewed to identify any complications of hypertensive disorders. Results A total of 368 women were analyzed. Of 10 maternal deaths, three (30.0%) were due to hypertensive disorders in pregnancy, and specifically pre-eclampsia. Overall, 168 (45.7%) women with hypertensive disorders in pregnancy delivered by cesarean, 16 (4.3%) had placental abruption, 11 (3.0%) had pulmonary edema, 3 (0.8%) had HELLP syndrome, 2 (0.5%) had acute renal failure, 3 (0.8%) had an intracerebral hemorrhage or cerebrovascular accident, 21 (5.7%) were admitted to the intensive care unit, 7 (1.9%) had disseminated intravascular coagulation, and 58 (15.8%) had eclampsia. Cesarean delivery, admission to intensive care unit, and eclampsia were significantly more common in women with pre-eclampsia than in those with other hypertensive disorders. Conclusion Hypertensive disorders in pregnancy are associated with high incidences of adverse maternal outcomes in Ghana, with significantly increased frequencies in women with pre-eclampsia.
    International Journal of Gynecology & Obstetrics 12/2014; 5(1). DOI:10.1016/j.ijgo.2014.06.010 · 1.54 Impact Factor
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    • "The course, prognosis, and outcome of this disease are quite heterogeneous and there exists great difference in the morbidity and outcome in the patients of developing and developed world. While there is lack of data from developing countries, studies from the developed world have reported complications in less than 10% [3–5]. Recently, great interest has been shown by investigators all around the world to find out predictors/markers that can predict the maternofoetal outcome in patients with preeclampsia [6–8]. "
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    ABSTRACT: Objective. To investigate association between maternofoetal complications and the amount of proteinuria measured by spot urine protein creatinine ratio in patients with preeclampsia. Methods. 200 consecutive patients with preeclampsia were recruited in the study. The complications like first episode of severe hypertension, renal insufficiency, raised level of aspartate transaminase, signs of neurological involvement, thrombocytopenia, eclampsia, and need to shift in intensive care units were studied. The maternal outcome was studied in terms of type of labour, outcome of pregnancy, mode of delivery, indication of cesarean section, and maternal mortality. The foetal complications and outcome parameters were birth weight, Apgar score at the time of birth and at five minutes, need of high dependency unit care, and perinatal mortality. Result. The frequency of various maternal and foetal complications was between 14-53% and 22-92%, respectively. Maternal mortality was 3%, whereas perinatal mortality was 23%. Statistically significant association was found between the frequencies of various complications in mother and newborn and spot UPCR. Conclusion. The rate of various maternofoetal complications in preeclampsia is higher in developing countries than in developed world. Maternofoetal complications and outcome correlate with maternal spot UPCR.
    Journal of pregnancy 04/2014; 2014:431837. DOI:10.1155/2014/431837
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    • "Given the growing global epidemic of diabetes and obesity, preterm birth rates will likely be driven higher by this relationship. Our findings also support studies that have implicated urinary tract infections [45] and pre-eclampsia [46,47] in preterm birth. Pre-eclampsia is a leading indication for piPTB [46] - the lower magnitude risk of piPTB in African countries (AOR 3.59) compared to overall (AOR 8.17) likely reflects a relatively lower number of women with pre-eclampsia being managed with caesarean, or perhaps comparative overuse in other settings. "
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    ABSTRACT: Preterm birth (PTB) (<37weeks) complicates approximately 15 million deliveries annually, 60% occurring in low- and middle-income countries (LMICs). Several maternal morbidities increase the risk of spontaneous (spPTB) and provider-initiated (piPTB) preterm birth, but there is little data from LMICs. We used the WHO Global Survey to analyze data from 172,461 singleton deliveries in 145 facilities across 22 LMICs. PTB and six maternal morbidities (height <145 cm, malaria, HIV/AIDS, pyelonephritis/UTI, diabetes and pre-eclampsia) were investigated. We described associated characteristics and developed multilevel models for the risk of spPTB/piPTB associated with maternal morbidities. Adverse perinatal outcomes (Apgar <7 at 5 minutes, NICU admission, stillbirth, early neonatal death and low birthweight) were determined. 8.2% of deliveries were PTB; one-quarter of these were piPTB. 14.2% of piPTBs were not medically indicated. Maternal height <145 cm (AOR 1.30, 95%CI 1.10-1.52), pyelonephritis/UTI (AOR 1.16, 95%CI 1.01-1.33), pre-gestational diabetes (AOR 1.41, 95%CI 1.09-1.82) and pre-eclampsia (AOR 1.25, 95%CI 1.05-1.49) increased odds of spPTB, as did malaria in Africa (AOR 1.67, 95%CI 1.32-2.11) but not HIV/AIDS (AOR 1.17, 95%CI 0.79-1.73). Odds of piPTB were higher with maternal height <145 cm (AOR 1.47, 95% CI 1.23-1.77), pre-gestational diabetes (AOR 2.51, 95%CI 1.81-3.47) and pre-eclampsia (AOR 8.17, 95%CI 6.80-9.83). Maternal height <145 cm, diabetes and pre-eclampsia significantly increased odds of spPTB and piPTB, while pyelonephritis/UTI and malaria increased odds of spPTB only. Strategies to reduce PTB and associated newborn morbidity/mortality in LMICs must prioritize antenatal screening/treatment of these common conditions and reducing non-medically indicated piPTBs where appropriate.
    BMC Pregnancy and Childbirth 01/2014; 14(1):56. DOI:10.1186/1471-2393-14-56 · 2.19 Impact Factor
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