Archives of Gynecology and Obstetrics

, Volume 273, Issue 1, pp 43–49 | Cite as

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

  • Gülseren Yücesoy
  • Sebiha Özkan
  • Harika Bodur
  • Temel Tan
  • Eray Çalışkan
  • Birol Vural
  • Aydın Çorakçı
Original Article

Abstract

Objective: The aim of the study was to determine the risk factors, prevalance, epidemiological parameters and maternal-perinatal outcome in pregnant women with hypertensive disorder. Materials and methods: 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. Results: 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 Conclusion: 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.

Keywords

Pregnancy Hypertension Maternal Perinatal Outcome 

References

  1. 1.
    Aali BS, Ghafoorian J, Mohamed-Alizadeh S (2004) Severe preeclampsia and eclampsia in Kerman, Iran: complications and outcomes. Med Sci Monit 10(4):163–167Google Scholar
  2. 2.
    Al-Ghamdi Saeed MG, Al-Harbi AS, Khalil A, El-Yahya AR (1999) Hypertensive disorders of pregnancy: prevalance, classification and adverse outcomes in northwestern Saudi Arabia. Ann Saudi Med J 6:557–560Google Scholar
  3. 3.
    American College of Obstetricians and Gynecologists (2002) Diagnosis and management of preeclampsia and eclampsia. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin no: 33. Int J Gynecol Obstet 77:67–75CrossRefGoogle Scholar
  4. 4.
    Chames MC, Livingston JC, Ivester TS, Barton JR, Sibai BM (2002) Late postpartum eclampsia: a preventable disease? Am J Obstet Gynecol 186:1174–1177CrossRefPubMedGoogle Scholar
  5. 5.
    Coppage KH, Polzin WJ (2002) Severe preeclampsia and delivery outcomes: is immediate cesarean delivery beneficial? Am J Obstet Gynecol 186:921–923CrossRefPubMedGoogle Scholar
  6. 6.
    Diejomaoh FME, Omu AE, Al-Busiri N, Taher S, Al-Othman S, Fatinikun T, Fernandes S (2004) Nitric oxide production is not altered in preeclampsia. Arch Gynecol Obstet 269:237–243CrossRefPubMedGoogle Scholar
  7. 7.
    Duley L (2003) Pre-eclampsia and the hypertensive disorders of pregnancy. Br Med Bull 67:161–176CrossRefPubMedGoogle Scholar
  8. 8.
    Foy R, Ramsay CR, Grimshaw JM, Penney GC, Vale L, Thomson A, Greer IA (2004) The impact of guidelines on mild hypertension in pregnancy: time series analysis. BJOG 111:765–770PubMedCrossRefGoogle Scholar
  9. 9.
    Gaio DS, Schmidt MI, Duncan BB, Nucci LB, Matos MC, Branchtein L (2001) Hypertensive disorders in pregnancy: frequency, and associate factors in a cohort of Brazilian women. Hypertens Pregnancy 20:269–281CrossRefPubMedGoogle Scholar
  10. 10.
    Geary M (1997) The HELLP syndrome. Br J Obstet Gynecol 104(8):887–891Google Scholar
  11. 11.
    Gofton EN, Capewell V, Natale R, Gratton RJ (2001) Obstetrical intervention rates and maternal and neonatal outcomes of women with gestational hypertension. Am J Obstet Gynecol 185:798–803CrossRefPubMedGoogle Scholar
  12. 12.
    Hanisch CG, Pfeiffer KA, Harald Schlebusch H, Schmolling J (2004) Adhesion molecules, activin and inhibin- candidates for the biochemical prediction of hypertensive diseases in pregnancy? Arch Gynecol Obstet 270:110–115CrossRefPubMedGoogle Scholar
  13. 13.
    Hernandez R, Lopez JL (2001) Preeclampsia and eclampsia: experience at the Cento Medic Nacional de Terreon. Ginecol Obstet Mex 69:341–345PubMedGoogle Scholar
  14. 14.
    Isler CM, Rinehart BK, Terrone DA, Martin PW; Magann EF, Martin JN (2000) Maternal mortality associated with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 183(2):444–448CrossRefPubMedGoogle Scholar
  15. 15.
    Katz VL, Farmer R, Kuller JA (2000) Preeclampsia into eclampsia: toward a new paradigm. Am J Obstet Gynecol 182:1389–1396CrossRefPubMedGoogle Scholar
  16. 16.
    Kullberg G, Lindeberg S, Hanson U (2002) Eclampsia in Sweden. Hypertens Pregnancy 21(1):13–21CrossRefPubMedGoogle Scholar
  17. 17.
    Kuschel B, Zimmermann A, Schneider KTM, Fischer T (2004) Prolongation of pregnancy following eclampsia. Eur J Obstet Gynecol Reprod Biol 113:245–247PubMedCrossRefGoogle Scholar
  18. 18.
    Lee W, O’Connell CM, Basket TF (2004) Maternal and perinatal outcomes of eclampsia: Nova Scotia, 1981–2000. J Obstet Gynaecol Can 26(2):119–123PubMedGoogle Scholar
  19. 19.
    Livingston CJ, Sibai BM (2001) Chronic hypertension in pregnancy. Obstet Gynecol Clin North Am 28:447–463CrossRefPubMedGoogle Scholar
  20. 20.
    Matthys LA, Coppage KH, Lambers DS, Barton JR, Sibai BM (2004) Delayed postpartum preeclampsia: an experience of 151 cases. Am J Obstet Gynecol 190:1464–1466CrossRefPubMedGoogle Scholar
  21. 21.
    McCowan LM, Buist RG, North RA, Gamble G (1996) Perinatal morbidity in chronic hypertension. Br J Obstet Gynaecol 103:123–129PubMedGoogle Scholar
  22. 22.
    National High Blood Pressure Education Program Working Group (2000) Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 183:S1–S22CrossRefGoogle Scholar
  23. 23.
    Nisell H, Palm K, Wolff K (2000) Prediction of maternal and fetal complications in preeclampsia. Acta Obstet Gynecol Scand 79:19–23PubMedCrossRefGoogle Scholar
  24. 24.
    Sawhney H, Aggarwal N, Biswas R (2000) Maternal mortality associated with eclampsia and preeclampsia of pregnancy. J Obstet Gynecol Res 26(5):351–356CrossRefGoogle Scholar
  25. 25.
    Serdar S, Gür E, Çolakoğulları M, Develioğlu O, Sarandöl E (2003) Lipid and protein oxidation and antioxidant function in women with mild and severe preeclampsia. Arch Gynecol Obstet 268:19–25PubMedGoogle Scholar
  26. 26.
    Sibai BM (1996) Hypertension in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL (eds) Obstetrics: normal and problem pregnancies, 3rd edn. Churchill Livingston, New York, pp 935–996Google Scholar
  27. 27.
    Tranquilli AL, Giannibulo SR (2004) The weight of fetal growth restriction in 437 hypertensive pregnancies. Arch Gynecol Obstet 270:214–16CrossRefPubMedGoogle Scholar
  28. 28.
    Ventura SJ, Martin JA, Cortin SG, Mathews TJ, Park MM (2000) Births: final data for 1998 national vital statistics. Reports 48 (No.3)Google Scholar
  29. 29.
    Vigil-De Gracia P, Montufar-Rueda C, Ruiz J (2003) Expectant management of severe preeclampsia and preeclampsia superimposed on chronic hypertension between 24 and 34 weeks’ gestation. Eur J Obstet Gynecol Reprod Biol 107:24–27CrossRefPubMedGoogle Scholar
  30. 30.
    Walker JJ (2000) Preeclampsia. Baillieres Best Pract Res Clin Obstet Gynecol 14(1):57–71CrossRefGoogle Scholar
  31. 31.
    Xiong X, FraserWD (2004) Impact of pregnancy-induced hypertension on birth weight by gestational age. Ped Perinatal Epidemiol 18:186–191CrossRefGoogle Scholar
  32. 32.
    Zarean Z (2004) Hypertensive disorders of pregnancy. Int J Gynecol Obstet 87:194–198CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Gülseren Yücesoy
    • 1
    • 2
  • Sebiha Özkan
    • 1
  • Harika Bodur
    • 1
  • Temel Tan
    • 1
  • Eray Çalışkan
    • 1
  • Birol Vural
    • 1
  • Aydın Çorakçı
    • 1
  1. 1.Department of Obstetrics and Gynecology, School of MedicineUniversity of KocaeliKocaeliTurkey
  2. 2.Feneryolu-IstanbulTurkey

Personalised recommendations