scholarly journals Management and perinatal outcomes of hypertensive disorders of pregnancy in a low-resource setting in Indonesia

2021 ◽  
Vol 9 ◽  
pp. 205031212110601
Author(s):  
Kevin Dominique Tjandraprawira ◽  
Aria Yusti Kusumah ◽  
Azka Yumna Kamilah ◽  
Dhini Isti Putri ◽  
Mayang Rizky Ananta ◽  
...  
Keyword(s):  
Hellp Syndrome ◽  
Gestational Hypertension ◽  
Perinatal Outcomes ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Elevated Liver Enzymes ◽  
Lower Birthweight

Objectives: To provide up-to-date data concerning hypertensive disorders of pregnancy on maternal and neonatal profiles in Indonesia. Methods: Retrospective clinical audit on all pregnancy-associated hypertensive women between 1 January 2020 and 31 March 2020 at Cianjur General District Hospital. Results: Preeclampsia accounts for 66.8% (235/352) of hypertensive disorders of pregnancy, gestational hypertension 29% (102/352) and chronic hypertension 4.3% (15/352). Compared to other pregnant women, those with preeclampsia, on average, had higher systolic and diastolic blood pressures and poorer kidney (ureum and creatinine) and liver function (aspartate transaminase enzyme and alanine transaminase enzyme) profiles (p < 0.001, < 0.001, < 0.001, 0.003, 0.033 and 0.002, respectively), and required more intensive care admission. Neonates from women with severe forms of preeclampsia (eclampsia and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets)) had, on average, lower birthweight (p = 0.015 and 0.048, respectively) and birth length (p = 0.021, 0.017). Neonates from eclamptic mothers had poorer APGAR (appearance, pulse, grimace, activity and respiration) scores (p = 0.006 and 0.005, respectively). Conclusion: Hypertensive disorders of pregnancy exerts adverse maternal and neonatal outcomes, particularly among eclampsia and HELLP-syndrome neonates. Various challenges remain for optimal management.

scholarly journals Prevalence, Placenta Development, and Perinatal Outcomes of Women with Hypertensive Disorders of Pregnancy at Komfo Anokye Teaching Hospital

2020 ◽  
Author(s):  
S. P. Awuah ◽  
I. Okai ◽  
E. A. Ntim ◽  
K. Bedu-Addo
Keyword(s):  
Adverse Effects ◽  
Teaching Hospital ◽  
Gestational Hypertension ◽  
Perinatal Outcomes ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Placental Development ◽  
Medical Problems ◽  
Morphological Variations ◽  
Hypertensive Disorders

AbstractBackgroundOne of the most common medical problems associated with pregnancy is hypertension. Hypertensive disorders of pregnancy (HDP), which has been attributable to abnormal placentation may have adverse effects on both mother and foetus if left unchecked. The objective of this study was to determine the prevalence of Hypertensive Disorders of Pregnancy (HDP), the morphological variations of human placenta in HDP, and maternal and perinatal outcomes in HDP.Materials and MethodsThis was a prospective case-control study, conducted at Komfo Anokye Teaching Hospital (KATH), Ghana. The progression of pregnancy in normotensive and hypertensive pregnant women, and the eventual perinatal outcomes were closely followed. Statistical analysis was performed using IMB-SPSS version 23. Associations were considered significant at p values of ≤ 0.05.ResultsFrom a total of 214 deliveries recorded during the period of study, 84 (39.25%) were hypertensives. Forty four (52%) of the hypertensives had preeclampsia, 28 (33.3%) had gestational hypertension, 6 (7.1%) had eclampsia, 4 (4.8%) had chronic hypertension, and 2 (2.4%) had preeclampsia superimposed on chronic hypertension. The frequency of placental haematoma, placental infarction, and placental calcification in the normotensives were significantly (p=0.001) lower than that of the hypertensives. The mean placental weight (p = 0.01), placental volume (p = 0.001), placental diameter (p = 0.03), and placental thickness (p = 0.001) of the normotensives were significantly higher than those of the hypertensives. The number of normotensives in whom labour was induced, who had their babies delivered by caesarean section, and who were admitted after they had given birth were significantly (p=0.001) lower than that of hypertensives who underwent similar procedures. No stillbirths were recorded in the normotensives compared with four in the hypertensives. The number of babies delivered to the normotensives who were admitted to the NICU was significantly (p=0.001) lower than those delivered by hypertensives.ConclusionThere was a high prevalence of hypertensive disorders of pregnancy in the study site. The condition adversely affected placental development and perinatal outcomes. These adverse effects can be curtailed by embarking on a vigorous health education drive.

scholarly journals Partial HELLP Syndrome: maternal and perinatal outcome

2002 ◽  
Vol 120 (6) ◽  
pp. 180-184 ◽  
Author(s):  
Joelcio Francisco Abbade ◽  
José Carlos Peraçoli ◽  
Roberto Antonio Araújo Costa ◽  
Iracema de Mattos Paranhos Calderon ◽  
Vera Therezinha Medeiros Borges ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Hellp Syndrome ◽  
Laboratory Tests ◽  
Gestational Hypertension ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Chronic Hypertension ◽  
Maternal Complications ◽  
Blood Pressure Elevation ◽  
Elevated Liver Enzymes

CONTEXT: HELLP syndrome is a severe complication of pregnancy characterized by hemolysis, elevated liver enzymes and low platelet count. Some pregnant women develop just one or two of the characteristics of this syndrome, which is termed Partial HELLP Syndrome (PHS). OBJECTIVE: The objective of this study was to evaluate the repercussions on maternal and perinatal outcomes among women that developed PHS and to compare these women with those whose gestational hypertension or preeclampsia did not show alterations for HELLP syndrome in laboratory tests. DESIGN: Observational, retrospective and analytical study. SETTING: Maternity Department of Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil. SAMPLE: Pregnant or post-delivery women who had a blood pressure elevation that was first detected after mid-pregnancy, with or without proteinuria, between January 1990 and December 1995. MAIN MEASUREMENTS: Analysis was made of maternal age, race, parity, hypertension classification, gestational age at the PHS diagnosis, alterations in laboratory tests for HELLP syndrome, time elapsed to discharge from hospital, maternal complications, mode of delivery, incidence of preterm birth, intrauterine growth restriction, stillborn and neonatal death. RESULTS: Three hundred and eighteen women were selected; forty-one women (12.9%) had PHS and 277 of them (87.1%) did not develop any of the alterations of the HELLP syndrome diagnosis. Preeclampsia was a more frequent type of hypertension in the PHS group than in the hypertension group. None of the women with isolated chronic hypertension developed PHS. The rate of cesarean delivery, eclampsia, and preterm delivery was significantly greater in the PHS group than in the hypertension group. CONCLUSION: We observed that aggressive procedures had been adopted for patients with PHS. These resulted in immediate interruption of pregnancy, with elevated cesarean rates and preterm delivery. Such decisions need to be reviewed, in order to reduce the cesarean rate and the incidence of preterm delivery.

Basal Plate Myometrial Fibers and Hypertensive Disorders of Pregnancy: A Case–Control Study

2017 ◽  
Vol 21 (3) ◽  
pp. 296-299 ◽  
Author(s):  
Ann A Wang ◽  
Linda M Ernst ◽  
Emily S Miller
Keyword(s):  
Case Control Study ◽  
Gestational Hypertension ◽  
Case Control ◽  
Basal Plate ◽  
Common Finding ◽  
Pathological Examination ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Control Study

Introduction Basal plate myometrium (BPMYO), the pathological presence of myometrial fibers in the basal plate, is a common finding on pathological examination of the placenta, yet its clinical correlates are not well studied. As myometrial fibers are frequently located in proximity to poorly converted maternal spiral arteries, our objective was to determine whether BPMYO is associated with hypertensive disorders of pregnancy (HDP), a well-known clinical sequela of abnormal maternal artery remodeling. Methods This case–control study included women who delivered a live-born singleton gestation whose placentas were sent for pathological examination. Cases were women with HDP (gestational hypertension, preeclampsia, or HELLP syndrome) as defined by American College of Obstetricians and Gynecologists. Controls were women without HDP. Women with chronic hypertension were excluded. The primary outcome was the presence of BPMYO. Secondary outcomes included the pathologic stage of BPMYO and the incidence of pathologically defined accreta. Each outcome was compared between cases and controls in bivariable and multivariable analyses. Results Of the 306 women who met inclusion criteria, 230 (75%) had HDP. BPMYO was present in 99 (32%) of placentas. Compared to controls, cases were younger, had higher body mass index, and were more likely to have diabetes, be nulliparous, deliver preterm, and have had a prior cesarean. There were no differences in the incidence of BPMYO, stage of BPMYO, or incidence of pathologically defined accreta between cases and controls. These findings persisted after controlling for potential confounders. Conclusions Although BPMYO may be more common in the setting of abnormal placental vasculature, there is no significant association between BPMYO and HDP.

scholarly journals Thrombocytopenia in hypertensive disorders of pregnancy

2018 ◽  
Vol 7 (3) ◽  
pp. 848
Author(s):  
Rupakala B. M. ◽  
Ritika Gupta ◽  
Vishma H. Shetty ◽  
Sailakshmi M. P. A.
Keyword(s):  
Hellp Syndrome ◽  
Gestational Hypertension ◽  
Severe Thrombocytopenia ◽  
Hypertensive Disorders Of Pregnancy ◽  
Medical College ◽  
Normal Platelet ◽  
Hypertensive Disorders ◽  
Gestational Thrombocytopenia ◽  
Mild Preeclampsia ◽  
Foetal Outcome

Background: Thrombocytopenia is defined as a platelet count of less than 150×103 μl. It is commonly diagnosed and has attracted more interest from researchers during recent years, especially in Hypertensive disorders of pregnancy. This study was done to estimate the incidence of thrombocytopenia in pregnant women diagnosed with hypertensive disorders of pregnancy and to correlate its severity with the degree of thrombocytopenia.Methods: In the study 150 women admitted in the OBG Department at Rajarajeswari Medical College and Hospital, Bengaluru during August 2015-August 2016 were included. Hypertensive disorders of pregnancy cases were classified into: Gestational hypertension, mild preeclampsia, severe preeclampsia, haemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome and eclampsia. The incidence and severity of thrombocytopenia along with maternal and foetal complications encountered in the five groups were analysed. Data were arranged in Microsoft Excel version 2010, and statistically analysed by SPSS version 23.Results: Preeclampsia- mild (29.25%) and severe (22.5%), accounted for most of the cases followed by eclampsia (3%) and gestational HTN (1.5%). Among these hypertensive patients, mild thrombocytopenia was noted in 60 cases (40%), moderate thrombocytopenia 48 (32%), severe thrombocytopenia 12 (8%), and normal platelet counts 30 (20%) were noted. Poor maternal outcome was seen 10.67% cases due to HELLP syndrome and postpartum haemorrhage. Poor foetal outcome was seen in 16% cases due to intrauterine growth restriction and perinatal mortality.Conclusions: Hypertensive disorders of pregnancy is recognized as a major cause of gestational thrombocytopenia. Careful follow up during and after pregnancy is recommended.

Metformin Exposure and Risk of Hypertensive Disorders of Pregnancy in Patients with Type 2 Diabetes

2021 ◽  
Author(s):  
Jenna L. Racine ◽  
Jacquelyn H. Adams ◽  
Kathleen M. Antony ◽  
Kara K. Hoppe ◽  
Jesus I. Iruretagoyena ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Gestational Hypertension ◽  
Study Groups ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Confounding Variables ◽  
Key Points ◽  
Singleton Pregnancies

Objective Metformin has been found to have a role in promoting vascular remodeling and angiogenesis which may reduce the risk of developing preeclampsia. Prior studies have shown a decrease in the incidence of hypertensive disorders of pregnancy in patients with type 2 and gestational diabetes taking metformin. We hypothesize metformin exposure decreases the risk of developing hypertension in patients with type 2 diabetes. Study Design Retrospective cohort study from 2009 to 2019 of singleton pregnancies was complicated by type 2 diabetes. We compared patients who received metformin throughout pregnancy to those with no metformin exposure. The primary outcome was a hypertension composite defined as gestational hypertension, preeclampsia with or without severe features, HELLP syndrome, or eclampsia. Individual hypertensive outcomes and neonatal outcomes were secondarily evaluated. Logistic regression was used to adjust for confounding variables. Results A total of 254 pregnancies were included. Women exposed to metformin were significantly less likely to develop hypertension composite compared with nonexposed women (22.7 vs. 33.1%, aOR 0.53, 95% CI 0.29–0.96). The incidence of preeclampsia with severe features was also significantly lower in those who received metformin compared with those who did not (12.1 vs. 20.7%, aOR 0.38, 95% CI 0.18–0.81). There were no differences in preterm birth prior to 34 or 37 weeks, fetal growth restriction, or birth weight between the study groups. A subgroup analysis of women without chronic hypertension also had a significantly lower risk of developing preeclampsia with severe features (7.6 vs. 17.8%, aOR 0.35, 95% CI 0.13–0.94). Conclusion Metformin exposure was associated with a decreased risk of composite hypertensive disorders of pregnancy in patients with pregestational type 2 diabetes. These data suggest that there may be benefit to metformin administration beyond glycemic control in this patient population. Key Points

scholarly journals P0263A NEPHROLOGIST'S LOOK AT HYPERTENSIVE DISORDERS OF PREGNANCY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Bianca Covella ◽  
Luigi Rossi ◽  
Domenico Caringella ◽  
Maurizio Guido ◽  
Giorgina Piccoli ◽  
...  
Keyword(s):  
Uric Acid ◽  
Kidney Disease ◽  
Gestational Diabetes ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Coagulation Abnormalities ◽  
Family Medical History ◽  
High Prevalence

Abstract Background and Aims Preeclampsia (PE) is a pregnancy-related syndrome of variable severity that falls under the broad category of hypertensive disorders of pregnancy (HDP). The relationship between PE and chronic kidney disease (CKD) is not entirely understood. Once considered a self-limited disease healed by delivery, it is now acknowledged that PE is a marker of cardiovascular and kidney health in the long term. The aim of this study was to review the data of women with hypertensive disorders of pregnancy at our institution, to identify need and to organize a conjoint nephrology and obstetrical activity in our setting Method We retrospectively reviewed all the medical charts of the patients hospitalized in the last two years for hypertensive disorders of pregnancy and who delivered in our Hospital. The cohort was divided into two groups: gestational hypertension (GH) and PE. A descriptive analysis of the clinical-laboratoristic was performed (t-test for continuous data with normal distribution). Results We identified 93 cases of hypertensive disorders of pregnancy on a total of 3279 deliveries (2.8%), 47 GH and 46 PE [2 cases of HELLP syndrome and 1 of eclampsia included in the PE group]. These two groups showed similar mean age: 33.5±6 vs 34.9±6 years (p value= 0.25); serum creatinine (sCr) and uric acid at admission were statistically different, and higher in the PE group (sCr 0.57±0.15 and 0.66±0.2 – p=0.01 and uric acid 4.5±1.38 and 5.6±1.47 – p=0.01). Comorbidities were frequent in the PE group: thyroid disfunction was found in 17% of cases (7 hypothyroidism and 1 hyperthyroidism, all under treatment), coagulation abnormalities were present in 15% of cases (4 MTHFR mutation, 1 protein S deficiency, 1 prothrombin-gene mutation, 1 patient was positive for LLAC); gestational diabetes was diagnosed in 13% of the cases. We identified 1 renal transplant recipient, 1 IgA-vasculitis patient, 1 patient with family medical history positive for PE (in her twin sister); none of these patients had been identified as at high risk for PE. At hospital admission, 54% of the patients were on antihypertensive treatment, 7 of them for chronic hypertension and 18 for gestational hypertension (12 of these patients underwent a previous hospitalization during the same pregnancy, diagnosed with gestational hypertension); at admission only 24% of PE patients were treated with anticoagulant or antiplatelet prophylaxis. Caesarean section was performed in 36 cases (78%). All but one children live-born, the exception being a child from a multiple pregnancy (quadruplets). Conclusion A multidisciplinary approach and a nephrological follow-up are increasingly indicated in PE. Our series underlines a high prevalence of comorbidity or risk factors, including thyroid disfunction, gestational diabetes and coagulation abnormalities. The high prevalence (7/46) of chronic hypertension and the fact that the two patients with kidney disease were not identified as at risk for PE underlines the potential role for developing a synergic approach between nephrologist and obstetricians.

scholarly journals Perinatal outcomes of hypertensive disorders of pregnancy

2021 ◽  
Vol 35 ◽  
pp. 105-109
Author(s):  
S. Srinivasa ◽  
Muragesh Awati
Keyword(s):  
Antenatal Care ◽  
Perinatal Mortality ◽  
Gestational Age ◽  
Late Complication ◽  
Perinatal Outcomes ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
Group A ◽  
Group B

Objectives: Hypertensive disorders of pregnancy (HDP) are multisystem diseases, which include chronic (preexisting) hypertension, gestational hypertension, pre-eclampsia, eclampsia, and pre-eclampsia superimposed on chronic hypertension. These disorders may complicate 5%–10% of all pregnancies and are leading causes of maternal and perinatal mortality and morbidity worldwide. This study was done to assess the incidence of HDP and perinatal outcomes in comparison to normal pregnancy. The objectives of this study were to assess the incidence of HDP and its correlation with perinatal outcome. Materials and Methods: Eighty patients were enrolled for the study, Group A (cases) – 40 patients of HDP and Group B (controls) – 40 normotensive controls, these 40 normotensive controls were properly matched with Group A with respect to age and gestational age. The collected data were analyzed with IBM SPSS statistics software 23.0 Version XVII. Results: In Group A, 45% were gestational hypertensive patients, 35% were pre-eclamptic patients, 12.5% eclampsia, and 7.5% chronic hypertension. Perinatal morbidity and mortality were increased in HDP when compared with age and gestational age-matched controls. Perinatal mortality was seen in 10% in Group A. In Group B(controls) there were no perinatal mortalities. Conclusion: The study demonstrated that high parity, low gestational age, lack of antenatal care, having eclampsia, pre-delivery onset of HDP, vaginal delivery, low fetal birth weight, and maternal death were independent predictors of perinatal mortality. The majority of perinatal mortality predictors were also predictors of stillbirths. The strong association of perinatal mortality with eclampsia (a late complication of HDP in the majority) and lack of antenatal care is an indirect evidence for the delay in the utilization of obstetric services.

scholarly journals Impact of Hypertensive Disorders of Pregnancy on the Risk of Stroke Stratified by Subtypes and Follow-Up Time

Stroke ◽  
2022 ◽  
Author(s):  
Shih-Kai Hung ◽  
Moon-Sing Lee ◽  
Hon-Yi Lin ◽  
Liang-Cheng Chen ◽  
Chi-Jou Chuang ◽  
...  
Keyword(s):  
Time Trends ◽  
Hemorrhagic Stroke ◽  
Stroke Risk ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertensive Disorders ◽  
History Of ◽  
The Relationship

Background and Purpose: Hypertensive disorders of pregnancy (HDP) comprise 4 subtypes. Previous studies have not investigated the relationship between stroke risk, different HDP subtypes, and follow-up time, which was the purpose of this study. Methods: Data of 17 588 women aged 18 to 45 years who had a history of HDP in Taiwan from 2000 to 2017 was retrospectively reviewed. After matching with confounders, 13 617 HDP women and 54 468 non-HDP women were recruited. Results: HDP women had an adjusted hazard ratio (aHR) of 1.71 (95% CI, 1.46−2.00) for stroke, and 1.60 (1.35−1.89) and 2.98 (2.13−4.18) for ischemic and hemorrhagic stroke, respectively ( P <0.001 for all). The overall stroke risk in the HDP group was still 2.04 times 10 to 15 years after childbirth (1.47−2.83, P <0.001). Although the risks of both ischemic and hemorrhagic stroke persisted, their risk time trends were different. The risk of ischemic stroke reached peak during 1 to 3 years after childbirth with an aHR of 2.14 (1.36–3.38), while hemorrhagic stroke risk gradually increased and had an aHR of 4.64 (2.47−8.73) after 10 to 15 years of childbirth (both P <0.001). Among the 4 HDP subtypes, chronic hypertension with superimposed preeclampsia had the highest stroke risk (aHR=3.86, 1.91−7.82, P <0.001), followed by preeclampsia–eclampsia (aHR=2.00, 1.63−2.45, P <0.001), and gestational hypertension (aHR=1.68, 1.13−2.52, P <0.05); chronic preexisting hypertension had the lowest stroke risk (aHR=1.27, 0.97−1.68, P >0.05). Furthermore, multiple HDP combined with preeclampsia had aHR of 5.48 (1.14−26.42, P <0.05). Conclusions: The effect of HDP on the risk of future stroke persisted for up to 17 years, both for ischemic and hemorrhagic strokes. The presence of multiple HDP and preeclampsia further increase the stroke risk.

scholarly journals Postnatal assessment for renal dysfunction in women with hypertensive disorders of pregnancy

2021 ◽  
Author(s):  
Emmanouil Kountouris ◽  
Katherine Clark ◽  
Polly Kay ◽  
Nadia Roberts ◽  
Kate Bramham ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Dysfunction ◽  
Gestational Hypertension ◽  
Chronic Hypertension ◽  
Hypertensive Disorder ◽  
Hypertensive Disorders Of Pregnancy ◽  
Postpartum Visit ◽  
Protein Excretion ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy are associated with chronic kidney disease. Early detection of renal dysfunction enables implementation of strategies to prevent progression. International guidelines recommend review at 6–8 weeks postpartum to identify persistent hypertension and abnormal renal function, but evidence for the efficacy of this review is limited. Methods All women attending a specialist fetal-maternal medicine clinic for hypertensive disorders of pregnancy (pre-eclampsia, chronic hypertension, gestational hypertension) were invited for a 6–8 weeks postpartum review of their blood pressure and renal function in order to establish the prevalence and independent predictors of renal dysfunction. Renal dysfunction was defined as low estimated Glomerular Filtration Rate (eGFR < 60 ml/min/1.73 m2) or proteinuria (24-h protein excretion > 150 mg or urinary albumin-to-creatinine ratio > 3 mg/mmol). All women attending a specialist clinic for hypertensive disorders were invited for a 6–8 weeks postpartum review of their blood pressure and renal function. Demographics, pregnancy and renal outcomes were prospectively collected. Results Between 2013 and 2019, 740 of 1050 (70.4%) women who had a pregnancy complicated by a hypertensive disorder attended their 6–8 weeks postpartum visit. Renal dysfunction was present in 32% of the total cohort and in 46% and 22% of women with and without pre-eclampsia, respectively. Multivariate logistic regression demonstrated that independent predictors were pre-eclampsia, chronic hypertension, highest measured antenatal serum creatinine, highest measured antenatal 24-h urinary protein, and blood pressure ≥ 140/90 mmHg at the postnatal visit. Conclusions Renal dysfunction was present in one in three women with hypertensive disorders of pregnancy at 6–8 weeks postpartum. This includes women with gestational hypertension and chronic hypertension without superimposed pre-eclampsia, and thus these women should also be offered postnatal review. Graphic abstract

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