International Journal of Current Medical And Applied Sciences, 2015, September, 8(1),12-17.

IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327. Page | 12

Outcome of Pregnancies in Patients with Pregnancy Induced Hypertension.

Vikram Lokhande1 & Swati Shiradkar2

1Associate Professor,

2Professor & HOD, Department of obstetrics & Gynecology,

MGM’s Medical College, Aurangabad

[MS], India ----------------------------------------------------------------------------------------------------------------------------- ----------------------- Abstract: The incidence of perinatal loss and maternal morbidity in any country can well be taken as a measure of its performance in the field of obstetrical and neonatal care. There are many maternal and fetal factors responsible for adverse perinatal outcome. Among these maternal hypertension is an important one while it is surprising to find that some severely hypertensive women deliver normal healthy babies at term and some mildly hypertensive women have adverse perinatal outcome. The present study was carried out in the department of Obstetrics and Gynecology, MGM’s Medical College, Aurangabad. Total 2543 deliveries were performed in two years of duration, out of which 140 cases were of PIH and the incidence was found to be 5.5%. The incidence of PIH in found to be 5.5%. Majority of patients were in the age group < 19 years. 64% patients having OIH were from rural area. 51% of the patients were unregistered. 62% of the patients were primigravidae. 59% of patients had DBP> 110 mmHg and 36% had warning symptoms headache (20%), nausea and vomiting (12%), visual disturbances (4%). 60% of the patients had proteinuria. All patients required anti-hypertensive treatment of which, 87% received anti-hypertensive in their post natal period. 18% of the patients had eclampsia. 57% patients were delivered through caesarean section. 26% patients were less than 37 weeks of gestation. 62% of patients with severe PIH were terminated of which 26% were pre-term and 36% at term.39% of term babies were low birth weight and Apgar score less than 8 were 38%. 37% required NICU admissions and the percentage of stillbirths was 9%. This study shows that high incidence of Pre-eclampsia & eclampsia was found in more in women’s with complication like unbooked cases, Rural community, Teenage mothers & primigravida. Incidence of sever Pre-eclampsia & prematurity more in unbooked cases. Key words : Pre-eclampsia , eclampsia, pregnancy, perinatal.

Introduction: The incidence of perinatal loss and maternal morbidity in any country can well be taken as a measure of its performance in the field of obstetrical and neonatal care. There are many maternal and fetal factors responsible for adverse perinatal outcome. Among these maternal hypertension is an important one while it is surprising to find that some severely hypertensive women deliver normal healthy babies at term and some mildly hypertensive women have adverse perinatal outcome [1] .

This difference in the outcome must be due to some variables associated with hypertension e.g – maternal age, parity, antenatal care, nature and timing and type of delivery, degree of proteinuria, biochemical profile of mothers also can affect the perinatal outcome of the pregnancy. The common incidence of pre-eclampsia is 5% [2]. Incidence of Pregnancy induced hypertension in developing countries similar to the developed countries. But the incidence of severity is higher in developing countries. In India it is about 7-10%.

Address for correspondence: Dr. Vikaram Lokhande

Associate Professor, Department of obstetrics & Gynecology,

MGM’s Medical College and Hospital, Aurangabad [MS], India. Email: vikramlokhande@gmail.com

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Vikram Lokhande & Swati Shiradkar

Logic Publications @ 2015, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327.

Correlating these factors and outcome would be an important step in preventing maternal as well as perinatal morbidity and mortality. Present study was carried out with this background. In this study we have study the demographic profile of pregnant women’s with PIH and the maternal and perinatal outcome in pregnancies associated with PIH also correlate outcome with severity of the disease.

Material and Methods: The present study was carried in out Department of Obstetrics and Gynecology of MGM’s Medical College and Hospital, Aurangabad [MS]. A total of 100 women’s were included in this study.

Inclusion Criteria: Women attending antenatal ward or

Emergency admission to labour Room. Women with blood pressure of > 140/ 90

mmHg on two or more occasions 6 hours apart.

Patients with eclampsia. Patients were observed closely. The data was entered in a predesigned proforma. Babies Apgar score at 1 minute was noted and mother and baby was followed till discharge. Data was analysed using appropriate statistical tests.

Observation & Results: The present study was carried out in the department of Obstetrics and Gynecology, MGM’s Medical College, Aurangabad. Total 2543 deliveries were performed, out of which 140 cases were of PIH and the incidence was found to be 5.5%. The incidence of PIH in found to be 5.5%. Majority of patients were in the age group < 19 years. 64% patients having OIH were from rural area. 51% of the patients were unregistered. 62% of the patients were primigravidae. 59% of patients had DBP> 110 mmHg and 36% had warning symptoms headache (20%), nausea and vomiting (12%), visual disturbances (4%). 60% of the patients had proteinuria. All patients required anti-hypertensive treatment of which, 87% received anti-hypertensive in their post natal period. 18% of the patients had eclampsia. 57% patients were delivered through caesarean section. 26% patients were less than 37 weeks of gestation. 62% of patients with severe PIH were terminated of which 26% were pre-term and 36% at term.39% of term babies were low birth weight and Apgar score less than 8 were 38%. 37% required NICU admissions and the percentage of stillbirths was 9%. 18% patients had eclampsia of which 12% were ante-partum, 4% intra-partum and 2% post-partum , abruption was observed in 4%. PPH was seen in 4% of patients.

Table 1: Distribution of cases according to Age-Group, Area, Registration, Parity, Hypertension & Mode of Delivery:

Number Percentage Age-Group

15-19 48 48.0 20-25 32 32.0 26-35 20 2.0 35& Above Nil --

Area wise Rural 64 64.0 Urban 36 36.0

Registration

Unbooked 51 51.0 Booked 49 49.0

Parity-wise Primi 62 62.0 Multi 38 38.0

Delivery Term 74 74.0% Preterm 26 26.0%

Hypertension Mild 41 41.0 Severe 59 59.0

Mode of Delivery Vaginal 43 43.0 Caesarean 57 57.0

In the present study, out of 100 cases 48% of the cases with PIH were in age-group 15-19 years 32% & 22% PIH cases in age-group 20-25 & 26-35 years. No patient was found beyond 35 years. Majority of the women having PIH belonged to rural community (64%).while only 36% were Urban community. In the present study we found equal number of booked and unbooked women. Maximum cases (62%) with PIH was primigravidae & 38% were Multigravida. Majority of women’s were having Term delivery (74%) where as 26% only preterm delivery. In the present study , majority (59%) of PIH cases were having severe hypertension while 41% having Mild hypertension. 57% were having mode of delivery was caesarean & 43 % were Vaginal.

Vikram Lokhande & Swati Shiradkar

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Table 2 : Signs and Symptoms (n=36)

Number Percentage Signs and Symptoms (n=36)

Headache 20 20.0% Nausea and vomiting 12 12.0% Visual disturbance 04 04.0% Epigastric pain 00 00.0% No Signs & Symptoms 64 64.0%

Proteinuria < 1 + 40 40.0% 1+ to 3+ 54 54.0% >3+ 06 06.0%

Serum Uric Acid Level

<4.0 11 11.0% 4.1 to 5.5 31 31.0% 5.5 and more 58 58.0%

Anti-Hypertensive Treatment

Antenatal 31 31.0% Postnatal 87 87.0% Antenatal + Postnatal 27 27.0%

Anticonvulsant treatment (Magnesium sulphate) patients with severe PIH-59

Therapeutic 18 75.0%

Prophylactic 06 25.0%

In the present study, out of 100, 36% cases had warning symptoms of severe PIH, headache was the commonest symptom found in 20 cases, followed by nausea and vomiting in 12 cases. In the present study, 60% of patients had proteinuria of > 1+ , out of which 6% had > + proteinuria. 56% of cases had increased Serum Uric Acid level. All women’s of PIH required Antihypertensive treatment , in this 87% of women’s were required treatment in

postnatal period where as 31% women’s required in Antenatal period and 27% women’s were required treatment in Antenatal & postnatal period. In 59 case of Sever PIH , 24 cases required Anticonvulsant treatment (Magnesium sulphate) where in this 24 case 18 (75%) cases required Therapeutic Anticonvulsant treatment & 06 (25%) Prophylactic Anticonvulsant treatment.

Table 3: Vaginal (n=43)

Spontaneous Induced Total No. % No % No. %

Term 11 37% 19 63% 30 100% Preterm 07 54% 06 46% 13 100% Total 18 42% 25 58% 43 100% Out of 43 cases of Vaginal delivery, 30 (70%) were having term delivery in this 19 (63%) were induced & 11 (37%) were Spontaneous. Where as in 13 (30%) vaginal pre-term delivery , 07 (54%) & 6 (46%) were spontaneous & induced respectively. Table No. 4: Caesarean Section (n=57)

LSCS Elective Emergency Total PIH Other reason Failure of

induction Other

Term 12 05 16 11 44 Preterm 03 02 06 02 13 Total 15 07 22 13 57

Out of 57 LSCS women’s, 44 women’s were Term delivery & 13 were Preterm delivery. Out of 44 cases of Term delivery, 17 women were electively chosen LSCS, In this 17 Electively chosen women’s, 12 women’s of PIH positive & 05 women’s were chosen due to other reason.

Logic Publications @ 2015, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327.

International Journal of Current Medical And Applied Sciences [IJCMAAS], Volume: 8, Issue:1.

Table 5 : Termination for PIH (n=62) Mode of termination

Preterm Term Total Fetal Maternal Fetal Maternal

Vaginal 04 09 08 03 24 LSCS 10 03 18 07 38 Total 14 12 26 10 62

Out 62 termination of PIH women’s, 24 women’s were having Vaginal delivery & 38 women’s were having LSCS delivery. Out of that 26 were preterm & 36 were term delivery. Table 6: Neonatal outcome

Neonatal outcome Spontaneous Percentage Full term 77 77.0% Preterm 23 23.0% Total 100 100.0%

The 77 % Neonatal outcome were full term & 23% preterm. Table 7 : Weight of baby

Weight of baby (kg) N0.of babies percentage > 2 61 61% < 2 39 39% Total 100 100%

39% of babies were less than 2 Kg & 61% were more than 2 Kg. Table 8 : Apgar Score

Apgar Score No. of babies percentage >8-10 57 57% 5 – 8 33 33% <5 10 10% Total 100 100%

43% of the babies had Apgar score of < 8 , S/o Asphyxia. Table 9: Outcome of baby

Outcome of baby No. of babies With Mother 30 Required NICU 33 Required NICU admission and discharged 30 Required NICU admission died 07

37% of neonates were badly affected because of PIH, & 7 babies were died in NICU in this 4 babies were premature & 3 were septicemia. Table 10 : Maternal and Fetal Complications

Complications Antepartum Intrapartum Postpartum Total Eclampsia 12 04 02 18 Abruption 04 00 00 04 PPH 00 00 08 08 HELLPy 01 4 00 05 IUGR 23 00 00 23 IUD 05 00 00 05 Neonatal asphyxia 00 00 05 05 Fetal distress 18 16 00 34 Prematurity 00 00 27 27 Neonatal death 00 00 07 07

Out of all the maternal & fetal complications, Eclampsia (18%), Fetal Distress (34%) & premature babies (27%).

Vikram Lokhande & Swati Shiradkar

Logic Publications @ 2015, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327. Page | 16

Table 11: Postnatal Status (at the end of one week): Normal Same Total

Hypertension 92 08 100 Proteinuria 91 09 100

In 17% of women’s changes due to PIH did not disappear within one week, so they were advised follow up for 6 Weeks. Table 12: Maternal and Fetal Complications:

Complications Unbooked Rural < 19 yrs. Anaemia Primi Severe PIH 22 13 17 14 23 Eclampsia 10 08 11 06 17 Abruption 03 01 03 02 02 PPH 05 04 03 05 05 IUGR 15 11 19 10 21 Neonatal asphyxia 06 03 04 02 07 Prematurity 20 14 18 12 19 Neonatal death 03 03 03 01 03

Incidence of sever PIH was highest among unbooked cases (32%) and primigravida was (40%) . The Incidence of prematurity was also highest among unbooked cases (39.2%) and those <19 year of age (37.5%). Incidence of IUGR was highest among <19 years of age (39.5%) & primigravidae (32.2%).

Discussion: The incidence of PIH in this study was found to be 5.5.%. The relative incidence in various studies has been tabulated. Findings of this study was consistent with the Saudan P. et al [6] & Rotchell et al [2] study. The incidence of Pre-eclampsia:

Author Study period No. of women’s Incidence of Pre-eclampsia

Rotchell et al [2] 1998-2003 3026 6.3% Makhseed et al [3] 1998-2004 10407 1.68% Wacker et al [4] 1999-2004 51206 7.1% Conde Agudelo [5]et al 2000-2004 20277 5.0% Saudan et al [6] 1997-2005 77443 5.8%

The Majority of the women’s in present study were in age < 19 years i.e.48%.64% of the patients having PIH belongs to the Rural Community this observation were consistent to Telang et al ( 58.6%) [7]. Gestation was shorter in women with sever pre- eclampsia than in normotensive women. Study Low Apgar at

5 Min. Admission to NICU (10%)

Still Birth Perinatal Mortality Rate

Neonatal Mortality Rate

Saudan P, Brown et al [6]

29.1% 50.2% 15.2% 22.4% NR

Douglas KA [8] 22.3% 28% 22.2/1000 NR 32/1000 Rotchell YE et al [2] APGAR>6 NR NR 3.0% NR

Conde Agudelo [5] et al

APGAR<5 35 8.8% 12.4% 3.5%

Present study APGAR<8 38%

37% 9% NR 7%

NR: Not Reported

Conclusion: Pre-eclampsia & eclampsia remain as continuing problems worldwide with a higher incidence in developing countries. This study shows that high incidence of Pre-eclampsia & eclampsia was found in

more in women’s with complication like unbooked cases, rural community, Teenage mothers & primigravida. Incidence of sever Pre-eclampsia & prematurity more in unbooked cases.

Logic Publications @ 2015, IJCMAAS, E-ISSN: 2321-9335,P-ISSN:2321-9327.

International Journal of Current Medical And Applied Sciences [IJCMAAS], Volume: 8, Issue:1.

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