Author(s): Prabha Janakiram1, Uma Mohanraj2, Ramya Rajadurai3
Hypertensive disorders are a common cause of maternal morbidity and mortality and they have been recognised since the times of Hippocrates. Hypertension in pregnancy is defined as systolic blood pressure of more than or equal to 140 mmHg and diastolic blood pressure of 90mmHg or more, recorded on two occasions atleast 6 hours apart within 7 days. These disorders are a common cause of maternal morbidity and mortality complicating 3-10% of all pregnancies.1 The primary aim of this study is to establish the incidence, risk factors and its complications to mother and foetus. In cases of mild gestational hypertension, severe gestational hypertension with proteinuria(preeclampsia)and eclampsia and their effects on the maternal and foetal morbidity and mortality. In developing countries, hypertensive disorders of pregnancy has its own raised incidence of maternal morbidity and mortality.
MATERIALS AND METHODS
This is retrospective study conducted in Government K.A.P.V. Medical College, Trichy, South India. This is a tertiary health centre, where we receive complicated obstetric cases, sometimes in early stage or in late stages. This study is conducted from August 2016 to October 2016.Total number of deliveries during this period was 1440,of which 96 patients were diagnosed to have gestational hypertension, thus incidence accounts to 6.66%1 of which those with mild GHT found to be 2.36%,severe preeclampsia were 3.61%and incidence of eclampsia was 1.4%.We analysed the data of the mother, which included the age, parity, socioeconomic class, any risk factors for developing gestational hypertension, any associated risk factors, the mode of termination of pregnancy, maternal morbidity in the form of intensive care admission and number of days stayed there, usage of blood and blood products for treating disseminated intravascular coagulation and HELLP syndrome if any. The foetal outcome was studied and their association with maternal gestational hypertension where there was an increased incidence of preterm delivery, intrauterine growth restriction was noted.
The overall incidence of gestational hypertension observed in our study was 96 (6.66%). Incidences of mild gestational hypertension, severe preeclampsia and eclampsia were 2.36%, 3.61% and 1.4%, respectively. Maternal near-miss cases were 7 times more frequent in women with severe preeclampsia and that was increased upto 50 times more frequent in women with eclampsia, when compared with women without gestational hypertension. The unbooked status was 66.3%. Severe preeclampsia and eclampsia incidence was higher in the younger age group of less than 20years.Primigravida had the high incidence of gestational hypertension, mild gestational hypertension in them was 50.8%, and in severe preeclampsia, it was 57% in the primigravida. In mild gestational hypertension, the labour natural rate was 76.6%, whereas in severe preeclampsia, labour natural rate was 48%. Emergency caesarean section rate was low in mild preeclampsia of 17.6% and increased in severe preeclampsia 48.07%. Coming to the complications, mild gestational hypertension had abruption rate of 5.8% compared to 23.7% in severe preeclampsia. Preterm labour incidence was increased. Severe preeclampsia 57.6% compared to 20.8% in mild gestational hypertension. In foetal complications, intrauterine growth restriction occurred in 23.2% in severe preeclampsia, while no case had intrauterine growth restriction in mild gestational hypertension in our study.
The analysis of this database provides the increased incidence of maternal and foetal complications in patients with eclampsia and severe preeclampsia. Gestational hypertension is a medical disorder especially seen among young primigravidas particularly in rural areas where they have poor antenatal follow up. Hence, the need of early detection of gestational hypertension and effective management to be done to reduce both maternal and foetal morbidity and mortality.