{^1,2Assistant Professor, Department of Obstetrics and Gynaecology} {³Associate Professor, Department of Pediatrics}

Prakash Institute of Medical Science & Research, Islampur INDIA.

Email: kishkita@rediffmail.com   

Table 1: maternal characteristics

In present study at time of initial diagnosis, incidence of gestational hypertension, non-severe preeclampsia, severe preeclampsia and eclampsia was noted as 42.13 %, 30.56 %), 19.44 % and eclampsia 7.87 % respectively. Incidence of pregnancy induced hypertension patients changed 24 hours after delivery as gestational hypertension (28.7 %), non-severe preeclampsia (37.5 %), severe preeclampsia (24.07 %) and eclampsia (9.72 %). Particularly gestational hypertension patients progressed to preeclampsia group and 4 cases of preeclampsia had postpartum convulsions.

Table 2: Different types of pregnancy induced hypertension (n=216).

Majority of patients were delivered by vaginal route (66.20 %). Other modes of delivery were emergency LSCS (19.91 %), elective LSCS (7.87 %), vacuum delivery (4.17 %) and forceps delivery (1.85 %).

Table 3: Mode of delivery

In present study Maternal complications observed were eclampsia (9.72 %), postpartum haemorrhage (8.80 %), abruptio placentae (7.87 %), partial HELLP (6.94 %), HELLP (1.39 %), renal dysfunction (2.78 %), DIC (2.32 %) and pulmonary oedema (0.93 %).

Table 4: Maternal complications

Majority of neonates had birth weight > 2500 grams (72.59 %) and ≥8 APGAR score at 5 minutes after birth (90.24 %). Neonatal complications observed were IUGR (7.41 %), Prematurity (14.81 %), Low birth weight babies (17.13 %), respiratory distress syndrome (9.72 %), Meconium aspiration (6.02 %) and NICU admission (20.83 %). Neonatal outcome noted was intrauterine death (1.85 %), still birth (3.24 %), neonatal death (3.24 %) and rest of neonates were discharged with mother.

Table 5: Perinatal outcome in eclamptic patients

DISCUSSION

Out of the triad of infection, hemorrhage and hypertension, which are the top causes of maternal morbidity and mortality, the first two have been controlled to a great extent. Moreover, they are amendable to available modalities of treatment. Only hypertensive disease of pregnancy, as a group, remains difficult to prognosticate and manage. The hypertensive disorder in pregnancy includes chronic hypertension and the group of hypertensive disorders unique to pregnancy including gestational hypertension, preeclampsia and eclampsia. The spectrum of pregnancy induced hypertension ranges from mildly elevated blood pressures with minimal clinical significance to severe hypertension with multi-organ dysfunction Maternal age is considered as a major risk factor, commonly seen at extremes of common reproductive age. Young age at marriage which is associated with low educational and economic standards and consequently poor antenatal attendance which can be a major confounder.⁶ In study by Chaitra S et al.,⁷ prevalence of pregnancy induced hypertension was 8.8%. Out of 286 hypertensive pregnant women 80.06% were diagnosed as gestational hypertension, 14.68% as preeclampsia, 2.09% as eclampsia and 2.79 % as chronic hypertension. Maximum number of women was nulliparous (46.85%) and 21-25 years was the dominant age group (46.15%). It is more prevalent at term (49.65%). 27.97% had a vaginal delivery while 71.32% had a cesarean delivery. Preterm delivery was the most prevalent morbid outcomes (28.67%). 26.57% of the babies were low birth weight and 14.68% had intrauterine growth restriction. Similar findings were noted in presents study. In study by Tiwari A et al.,⁸ out of 180 cases of pregnancy induced hypertension, majority were of preeclampsia (47.22%), then Gestational hypertension 38.88%, percentage of eclampsia (13.88%). Incidence of low birth weight in PIH is 57.7%, preterm 44.2% and IUGR 20.4%, Still birth 8 (4.4%), early neonatal death 22 (12.2%), Highest incidence of LBW (88%), Preterm (80%), IUGR (12%) was present in eclampsia group. Singh A et al.,⁹ studied 224 patients, 40% were booked, 76.8% cases were of age group 21-30 years. About 58.9% of them were primigravida, 82.1% of presented at gestational age of ≥34 weeks and 5.4% were below 30 weeks About 14.2% patients of severe pre-eclampsia were delivered by LSCS, whereas cesarean rate in mild pre-eclampsia group was 7.2%. Prematurity (67.9%), perinatal mortality (12.5%), birth asphyxia (21.4%) of patients were noted. Partial HELLP and HELLP were seen in 37.5% of patients, eclampsia in 1.8% patients; other complications included DIC and pulmonary edema which was seen in 3.6% of cases each and maternal mortality rate was 1.8%. Similar findings were noted in present study. In study by D. P. Meshram et al.,¹⁰ maternal complications were HELLP syndrome (10 %), PPH (8 %), infections (3 %), ascites (6 %), acute renal failure (2 %), disseminated intravascular coagulation (DIC) (3 %), and maternal death (2 %). Fetal complications included IUGR (18 %) and perinatal death (27 %). Out of 32 patients with deranged coagulation profile, 84.37% women had adverse maternal outcome and 93.75% had unfavorable fetal outcome. Kolluru V et al.,¹¹ noted incidence of pregnancy induced hypertension as 7.9% (234 cases) of the total deliveries; out of which gestational hypertension, preeclampsia and eclampsia accounting for 2.1%, 4.9% and 0.9% of all deliveries. Commonest maternal complication was HELLP syndrome (3.4%) and there was no maternal mortality. Total number of preterm deliveries were 3.47% and perinatal mortality was seen in 23% cases. IUGR was the commonest fetal complication (33.4%). Hypertensive disorders of pregnancy are known to be associated with several perinatal complications which can be measured in terms of prevalence of preterm delivery, low birth weight, low Apgar score, intrauterine growth restriction, the need for resuscitation and/or admission to a neonatal intensive care unit (NICU), and stillbirths. In study by Pandya K et al.,¹² gestational Hypertension was most common (65.62%), followed by Preeclampsia (28.12%) and Eclampsia (6.25%). The most common fetal complications found were preterm births (43.75%) and LBW (37.5%). 28.12% babies required NICU admission due to various reasons whereas 6.25% neonatal deaths were reported. Presently screening modalities help early detection of the diseases and timely intervention of hypertensive disorders complicating pregnancy and provision of specialized systemic antenatal maternal care could reduce the impacts of such complications.

CONCLUSION

Preeclampsia and eclampsia continue to be significant causes of maternal and fetal morbidity and mortality. The adverse maternal and perinatal outcome can be reduced by regular antenatal checkups, early diagnosis, timely referral to tertiary care hospital and availability of specialist care during labour and after birth.

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