Study of hypertension disorders in pregnancy and outcome of neonates in Telangana population

 

 

Abstract              Background: Hypertensive disorders in pregnancy is a multi factorial disorder that, seriously endogenous the safety of the foetus during pregnancy and maternal morbidity and mortality. Method: Also 60 pregnant women selected for studies Blood examination CBC Blood culture, serum electrolyte CT, BT, was done. Foetal monitoring includes DFMC. FHR, NST umbilical and cerebral Doppler, USG to assess the foetal serial growth, AFI, BPP, placental location and maturity. Results: Types of delivery were 38 (63.3%) LCSC, 15 (25%) NVD 2 (3.3%) forceps delivery, 5 (8.3%) consanguity, 11 (18.3%) patients had < 140 systolic, 90 diastolic BP, 34 (56.6%) had 140-159 systolic 90-109 diastolic BP, 15 (25%) had > 160 systolic and > 110 diastolic BP. In the gestational age study 7 (11.6%) patients had 32 weeks, 12 (20%) had 32-36 weeks, 41 (68.3%) had 37-42 weeks of gestation, 27 (45%) were LBW, 10 (16.6%) were very low birth weight, 19 (31.6%) had normal birth weight, 18 (30%) were IUGR. The foetal outcome study had 47 (78.3%) were alive, 13 (21.6%) had neonatal death. Conclusion: Early detection and management death of pre clampsia, proper antenatal care, timely referral of high risk patient to higher centres where all facilities and specialities are available. Administration of MgSo₄ in correct doses and proper timed caesarean will certainly reduce the incidence of eclampsia associated with incidences of maternal and perinatal morbidity and mortality.

Keywords: HTN, NgSo₄ IUGR, LBW, Gestational age, eclampsia.

 

INTRODUCTION

Hypertension (HTN) disorder of pregnancy is the major cause of poor pregnancy outcome that encountered during pregnancy¹. HTN in pregnancy defined as abnormal raising of blood pressure which diagnosis as chronic HTN, gestational HTN, mild pre-eclampsia, severe preeclampsia or/and eclampsia². In India and abroad 10-15% of pregnant women affected with HTN which cause substantial maternal and infant morbidly and mortality³. About 70% maternal deaths were attributed to five major complications Haemorrhage, infections unsafe abortion, Hypertensive disorders in pregnancy and obstructed labour. HTN in pregnancy increases serious risk of maternal and new born baby such as premature delivery, IUGR prenatal mortality and morbidity, acute renal failure, acute hepatic failure, bleeding at the time of delivery and post partum bleeding. Maternal mortality and morbidity following harm, such as disseminated intravascular coagulation (DIC) and seizures⁴. Hence the magnitude of HTN in pregnancy is evaluated in detail.

 

 

MATERIAL AND METHOD

Sixty (60) pregnant women regularly visiting obstetrics and Gynaecology department of Mediciti Institute of Medical Science HG Ghanpur Medchal-501401 Telangana were studied.

Inclusive Criteria: Pregnant women having history of HTN, gestation HTN, preeclampsia, eclampsia, essential HTN were selected for study.

Exclusion Criteria: Pregnant women have diabetes mellitus, gestation diabetes, Thyroid disorders; history of epilepsy was excluded from study.

Method: Antenatal check up (ANC) gestational age determined by last menstrual period (or first trimester, USG) was recorded. HTN disorders, obstetric problems like preterm labour was recorded. In addition to this Neonatal parameters like gestational age, birth, weight, respiratory distress syndrome, congenital pneumonia, and convulsion were also recorded. Blood examination included – CBC (complete Blood count) blood culture serum electrolytic coagulation and bleeding time (CT, BT) was also noted. Foetal monitoring included – DFMC, FHR, NST, umbilical Doppler, USG was done to assess foetal serial growth, AFI, BPP placental location and maturity. Treatment included rest, control of blood pressure by using antihypertensive drugs Nefidepine, Methyldopa, Labetalol depending upon the severity of BP (Blood pressure) for control of seizure anticonvulsants, MgSo₄, IV was given slowly over 5-10 minutes and 5 gm of 50% MgSo₄ I M 4 hourly (in alternate gluteus region). In mild preeclampsia and gestational HTN termination of pregnancy was done by inducing labour at 37 weeks at this gestational age. In patients <37 weeks of gestation termination of pregnancy was warranted only if maternal condition detoraited or if there was foetal compromise. Pregnancy was terminated by LSCS for urgent termination a for maternal shake as in the acute fulminating preeclampsia and eclampsia when cervixes are not ripe and also for foetal sake when foetal was in jeopardy as indicated by de-arranged Doppler studies (reveres diastolic flow), severe IUGR, meconicum staining of liquor or foetal distress. The duration of study was three years (July-2017 to August-2020).

Statistical analysis: Types of delivery, various HTN disorders, gestational ages, different body weight of Neonates, outcomes at birth, were classified with respective percentage. The statistical analysis was done in SPSS software.

This research paper was approved by ethical committee Mediciti Institute of Medical Sciences Ghanpur – medchal – 501401. Telangana.

 

 

 

 

OBSERVATION AND RESULTS

Table – 1: Study of types of delivery in HTN pregnancy – 38 (63.3%) LCSC, 15 (25%) by NVD, 2 (3.33%) forceps delivery, 05 (8.33%) consanguity.

Table – 2: Study of parameters of HTN in pregnancy – 11 (18.3%) patients had <140 systolic and 90 mm Hg diastole, 34 (56.6%) patients had 140-159 mm/Hg systolic and 90-109 mm/Hg diastole, 15 (25%) had > 160 mm/Hg systole, > 110 diastole

Table – 3: Study of gestational age in HTN pregnancy – 7 (11.6%) had > 32 weeks gestation, 12 (20%) had 32-36 weeks, 41 (68.3%) had 37-42 weeks.

Table – 4: Study birth weight of Neonates in HTN pregnancies – 27 (45%) were LBW 10 (16.6%) very low birth weight, 19 (31.6%) had normal birth weight, 18 (30%) had IUGR.

Table – 5: Outcomes of Neonates in HTN pregnancies – 47 (78.3%) alive, 13 (21.6%0 neonatal death.

 

Table 1: Types of delivery in HTN pregnant Women

(LCSC = Lower Uterine Caesarean Section) (NVD = Normal Vaginal Delivery)

 

 

Table 1: Types of delivery in HTN pregnant Women

 

Table 2: Study of HTN in pregnant Mother

 

 

Table 2: Study of HTN in pregnant Mother

 

 

Table 3: Study of gestational in HTN pregnancy

 

Table 3: Study of gestational in HTN pregnancy

 

Table 4: Study of Body weight of Neonates in HTN pregnancy

 

 

Table 4: Study of Body weight of Neonates in HTN pregnancy

 

Table 5: Study of foetal outcome in HTN in pregnancy

 

Table 5: Study of foetal outcome in HTN in pregnancy

 

DISCUSSION      

In the present study of HTN disorders in pregnancy and outcome of emanates in Telanganan Population. The types of deliveries were 38 (63.3%) LCSC, 15 (25%) NVD, 2 (3.33%) forceps delivery, 5 (8.33%) consanguity (Table-1). In the profile of HTN 11 (38%) had < 140 systolic, 90 mmHg diastolic BP, 34 (56.6%) had 140-159 systolic, 90-109 Diastolic BP, 15 (25%) had > 160 Systolic and > 110 diastolic BP (Table-2). The gestational age study shown 7 (11.6%) had <32 weeks, 12 (20%) had 32-36 weeks, 41 (68.3%) had 37-42 weeks of gestation (Table-3). 27 (45%) were LBW, 10 (16.6%) were very LBW, 19 (31.6) had normal birth weight, 18 (30%) had IUGR (Table-4). 47 (78.3%) were alive and 13 (21.6%) were neonatal death (Table-5). These findings were more or less in agreement with previous studies^5,6,7. As majority of people are illiterate belonged to middle socio-economic status hence they come to hospital only when there is any serious problems hence eclampsia is often missed. More over pre eclampsia is asymptomatic and remits spontaneously. In addition to this, there are many predisposing factors related to preeclampsia, such as maternal age, familial aggregation, and race, smoking, socio-economic level, diet, and family history⁹. Apart from this It is established fact that, majority of Indian women are suffering with obsessive compulsive disorder (OCD). This internal agitation, non-compromising attitude elevates the hypertension even during pregnancy. It was also reported that, causes of maternal deaths were due to intra cerebral haemorrhage, aspiration pneumonia, and intractable congestive cardiac failure¹⁰. Multiple pregnancy and multiparty also significantly associated with HTN in pregnancy which included renal and cardiovascular diseases ⁽¹¹⁾. Hence antenatal care is must to avoid preeclampsia and further complication

 

 

 

SUMMARY AND CONCLUSION

The present of HTN disorders in pregnancy and its outcomes of neonates in Telangana population is quite useful to obstetric and gynaecologist, cardiologist to treat such patients efficiently because magnitude and pathogesis of eclampsia is still unclear.

 

REFERENCES

1. FMOH management protocol on selected obstetric topics, Addis Ababa Ethiopia 2010.
2. Karen L, Jean Moiré M – Diagnosis, Evaluation and management of the hypertonic disorders of pregnancy SIGC clinical practice guide line 2014, 307-10.
3. Carole G, Rooney C – How effective antenatal care in preventing maternal mortality and serious morbidity, paediatric perinatal epidemiology 2001, 15(1), 13-20.
4. Hutch eon J. A, Lison Kova S – Epidemiology of preeclampsia and the other hypertensive disorder of pregnancy pub-med. Best pract Res. Clin. Obstet Gynae. 2011, 25, 391-401.
5. Shah A, Fawole B – Caesarean delivery outcomes from the WHO global surrey on maternal and preinatal health in Africa. Int. J. Gynecol. Obst. 2009, 107 (3), 191-7.
6. Mc Colure EM Saleem S Pasha O – Still birth in developing countries review and causes, J. Maternal foetal/neonatal Med. 2009, 22 (3), 183-90.
7. Prakash J, Pandey LK – Hyper tension in pregnancy hospital based study, J. Assoc. Physicians India. 2006, 54, 273-8.
8. Yadhav S, Scxana U – Hypertensive disorders of pregnancy and maternal and foetal outcome J. Ind. Med. Assoc. 1997, 95, 548-51.
9. EsKes TK, Lean C – Chesley and hypertension in pregnant women Eur. J. Obstet. Gynecol. Reprod. Biol. 2000, 90, 181-6.
10. Shambel Wodaja, P. Surendra Reddy – Hypertensive disorders of pregnancy and associated factors in north Ethiopic Medical research chronicles 2018, http://medrech.com/index/nnn/view/179/Fr viewed on 18-10-2020.
11. Myles W, Anand S – Differential risk of Hypertensive disorders of pregnancy among Hispanic women J. of American society of Nephrology 2004, http://josn.asjournal.org.content15/5/1330 viewed in 18-10-2020.

 

 

 

 

 

Policy for Articles with Open Access
Authors who publish with MedPulse International Journal of Anesthesiology (Print ISSN:2579-0900) (Online ISSN: 2636-4654) agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.