Severe preeclampsia and eclampsia: adverse obstetric outcomes and prognostic factors

Fetal Outcomes ◽

Hypertensive Disorders ◽

Background: Hypertensive disorders of pregnancy are globally a threat to maternal and fetal outcomes. Despite massive efforts worldwide, these disorders continue to be a major adverse influence on the health goals especially in developing countries. The aim of the study was to measure the impact of hypertensive disorders of pregnancy in its most severe form on maternal and fetal outcomes in our region along with the important prognostic factors. The objective of this study was to investigate the maternal and fetal outcome in cases of severe preeclampsia and to evaluate the risk factors and complications associated with adverse outcomes.Methods: Indoor records of pregnant females at more than 20 weeks gestation with preeclampsia with severe features (as defined by the ACOG practice bulletin 222) and eclampsia admitted over a period of one year in a unit of obstetrics at Government Medical College, Amritsar were studied and results were statistically analysed.Results: The incidence of hypertension in pregnancy was 11.85% while that of severe preeclampsia was 6.14%. 57.94% of these women were primigravida’s and 80.16% of the women with severe preeclampsia/eclampsia were in the age group 20-29 years. Severe preeclampsia and eclampsia contributed to 43.75% of maternal deaths (OR 8.8, p value=0.0001) and there was increased incidence of stillbirth (OR 10.03, p value<0.0001) and perinatal mortality (OR 12.97, p value<0.0001). The incidence of preterm birth in cases with severe preeclampsia/eclampsia was 57.14%. Severe anemia as a comorbidity along with respiratory distress and renal impairment were associated with increased probability of maternal death.Conclusions: In addition to ensuring the implementation of routine management principles of, the policy makers should focus on developing critical obstetric care and NICU infrastructure along with dedicated human resources at obstetric centres to manage these high-risk cases. Improvement in the quality of antenatal care can help in diagnosing such patients before the onset of severe features so as to optimize maternal and neonatal outcomes.

Outcome of Hypertensive Disorders of Pregnancy

Community Based Medical Journal ◽

10.3329/cbmj.v3i1.53329 ◽

2014 ◽

Vol 3 (1) ◽

pp. 46-52

Author(s):

Akhter Zahan ◽

Md Nazrul Islam ◽

Netay Kumer Sharma ◽

Khadiza Begum ◽

Kinkon Rani Bhowmik

Keyword(s):

Birth Weight ◽

Severe Preeclampsia ◽

Neonatal Outcomes ◽

Maternal Complications ◽

Cross Sectional ◽

Hypertensive Disorders ◽

Mild Preeclampsia ◽

Adverse Pregnancy ◽

Hypertension is the most common medical problem encountered in pregnancy and are leading causes of maternal, fetal and neonatal morbidity and mortality worldwide. Definitions, classifications, assessment and management of hypertensive disorders vary considerably in the literature and from country to country. In light of this, we aimed to evaluate different types of hypertensive disorders of pregnancy and to determine the impact of hypertensive disorders of pregnancy (HDP) on maternal, fetal and neonatal outcomes. This Cross Sectional descriptive study was conducted in the Department of Gynaecology and Obstetrics of Community Based Medical College, Mymensingh, Bangladesh from April 2012 to March 2013. All the patients who were diagnosed with HDP and gestational age of 20-40 weeks during the study period were included in the study. Patients with preexisting renal disease, diabetes mellitus, active urinary tract infection or who refused to cooperate with the study were excluded. The data regarding demographic variables, clinical features, pregnancy characteristics, maternal complications, fetal and neonatal outcomes were gathered from available data on medical record files. Edema was the most common clinical symptom. Primipara mothers were predominant in the both mild and severe preeclampsia group. Majority (88%) of mothers in mild preeclampsia group had a history of spontaneous vaginal birth, however 82.9% in severe preeclampsia group by Lower Segment Caesarean Section (LSCS). A higher proportion of mother in mild preeclampsia group delivered at term, whereas 65.7% in severe preeclampsia group delivered preterm. The proportion of maternal complications such as were significantly higher in severe preeclampsia group than those in mild preeclampsia group. Most babies (92%) were born with a birth weight 2500 grams in mild preeclampsia group, while 70% born with birth weight between 1500 - 2499 grams in severe preeclampsia group. All the babies were born with apgar score less than 7 between mild and severe preeclampsia groups. About three quarter (74.3%) of neonates born to women the severe preeclampsia group required resuscitation compared to 40% in mild preeclampsia group. The maternal death, still birth and neonatal death were found higher in severe preeclampsia group than those in mild preeclampsia group. Pregnancies affected by hypertensive disorders require careful monitoring due to the increased risks of adverse pregnancy outcomes. Frequency of severe hypertensive disorders is high in our set up. It is associated with high maternal, fetal and neonatal mortality CBMJ 2014 January: Vol. 03 No. 01 P: 46-52

Maternal and fetal outcome in women with hypertensive disorders of pregnancy: the impact of prenatal care

Therapeutic Advances in Cardiovascular Disease ◽

10.1177/1753944715597622 ◽

2015 ◽

Vol 9 (4) ◽

pp. 140-146 ◽

Cited By ~ 14

Author(s):

Isabela Roberta Cruz Barbosa ◽

Wesley Bruno Merencio Silva ◽

Grace Sanches Gutierrez Cerqueira ◽

Neil Ferreira Novo ◽

Fernando Antonio Almeida ◽

...

Keyword(s):

Prenatal Care ◽

Fetal Outcome ◽

Hypertensive Disorders ◽

Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-046638 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046638

Author(s):

Sk Masum Billah ◽

Abdullah Nurus Salam Khan ◽

S M Rokonuzzaman ◽

Nafisa Lira Huq ◽

Marufa Aziz Khan ◽

...

Keyword(s):

Primary Care ◽

Health Workers ◽

Gestational Hypertension ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Hypertensive Disorders ◽

Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center

BMC Nephrology ◽

10.1186/s12882-021-02418-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xin Li ◽

Xiaojing Wu ◽

Muyin Zhang ◽

Lili Xu ◽

Guohui Li ◽

...

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

High Altitude ◽

Kidney Injury ◽

Fetal Outcomes ◽

Uncontrolled Blood Pressure ◽

Logistic Regression Models ◽

Hypertensive Disorders ◽

Term Delivery

Abstract Background Pregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature. Objectives to investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude. Methods 6,512 pregnant women attending the Department of Obstetrics & Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(> 70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed. Results Pr-AKI was identified in 136/6512(2.09 %) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3 %). 4(2.9 %) women died and the majority(86.1 %) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age ≥ 20 weeks. Pre-term delivery occurred in 30(27.3 %) cases and perinatal deaths in 17(15.5 %). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0 and 10.9 % respectively. 16(14.5 %) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3 %). More IUGR(25.0 %) and LBWI(37.8 %) were observed in their infants with a higher risk of admission to NICU(22.0 %). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients. Conclusions Pr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

Fetal Outcome in Hypertensive Disorders of Pregnancy.

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v12i1.9083 ◽

2013 ◽

Vol 12 (1) ◽

pp. 8-10 ◽

Cited By ~ 1

Author(s):

Arju Chand Singh ◽

Sadikchya Singh Rana

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Antihypertensive Drugs ◽

Gestational Hypertension ◽

Fetal Outcome ◽

Intrauterine Fetal Death ◽

Hypertensive Disorders ◽

Study Results ◽

Low Birth Weight Babies

Introduction: Hypertensive disorders are the most common medical complications of pregnancy, affecting approximately 5-10% of pregnancies and the major cause of maternal and infant disease and death worldwide. Very few researches have been done in Nepal to analyze the effect of hypertension in fetus. The aim of this study was to determine the incidence and perinatal morbidity of hypertensive disorders of pregnancy. Methods: This was a hospital based prospective observational study conducted at Paropakar Maternity and Women’s hospital. The study was conducted from 18th October to 22nd December 2007. All primi and multigravid patient with BP ≥140/90 mmHg after 28 weeks of pregnancy were included in the study. Women with a blood pressure ≥140/90mmHg at or before 20 weeks of gestation, previous hypertension or women on antihypertensive drugs and Intrauterine fetal death (IUFD) were excluded from the study. Results: A total of 126 cases of hypertensive disorders of pregnancy were identifi ed among 3819 obstetric cases. The incidence of hypertensive disorders of pregnancy was 3.3%. Among 100 cases who were included in the study, 42 had pre eclampsia and 58 had gestational hypertension. Among 42 preeclamptic patients, 15(35.71%) had low birth weight babies, and 9(15.5%) babies had low birth weight among 58 gestational hypertensive mothers. Conclusions: Preeclampsia increases the risk of intrauterine growth restriction, low birth weight and stillbirth.Medical Journal of Shree Birendra Hospital; January-June 2013/vol.12/Issue1/8-10DOI:http://dx.doi.org/10.3126/mjsbh.v12i1.9083

Morphological and morphometrical study of placenta in normal and hypertensive pregnancies.

National Journal of Clinical Anatomy ◽

10.1055/s-0039-1700715 ◽

2014 ◽

Vol 03 (01) ◽

pp. 24-28

Author(s):

Pushpa Gowda ◽

Jayanthi KS

Keyword(s):

Surface Area ◽

Fetal Outcome ◽

Control Group ◽

Chronic Hypertension ◽

Hypertensive Group ◽

Hypertensive Disorders ◽

The Mean ◽

Placental Volume ◽

Morphometrical Study

Abstract Background and Aim: Placenta is the main channel in utero, through which the fetus receives its nutrition from the mother. Hypertensive disorders of pregnancy are fairly common and affect the growth and development of the placenta and fetus in many ways. Knowledge of these changes in placenta due to hypertension in pregnancy is essential as many of these changes can be diagnosed prenatally by available techniques to improve the fetal outcome and reduce perinatal morbidity and mortality. Materials and Methods: The present study was conducted to note the morphometrical and morphological parameters in the placenta of normal and hypertensive pregnancies and to correlate them with fetal outcome. The study was done on 30 placentae as control group, obtained after delivery of normotensive women and 30 placentae as study group, which were obtained after delivery of hypertensive mothers which included chronic hypertension, pre eclampsia and eclampsia. The placental specimens were collected from the department of obstetrics and gynecology, KIMS, Bangalore and new bom parameters were taken from their records. Results: The placental morphometrical parameters were significantly less in hypertensive group as compared to the control group. The mean placental weight was 458.33±70.47 gms; mean placental surface area was 215.82±27.83 sqcms, the mean placental volume was 583.67+66.21 cc and mean decidual thickness was 2.50 ±0.24 cms in hypertensive group while in the control group the values were 561.67±77.33 gms, 241.91±37.23 sqcms, 674.00±88.50 cc and 2.83±0.34 cms respectively. The mean birth weight (kg) of newborn was 2.92 ± 0.45 in control group and it was and 2.47 ±0.40 in hypertensive group. Conclusion: Thus hypertensive disorders of pregnancy affects the placenta in a major way by decreasing its weight, surface area, thickness and volume and by increasing pathological changes like placental infarcts and calcified areas which adversely affect fetal parameters like weight and APGAR score.

Temporal Changes in Hypertensive Disorders of Pregnancy and Impact on Cardiovascular and Obstetric Outcomes

The American Journal of Cardiology ◽

10.1016/j.amjcard.2020.02.029 ◽

2020 ◽

Vol 125 (10) ◽

pp. 1508-1516

Author(s):

Pensée Wu ◽

Carolyn A. Chew-Graham ◽

Angela HEM Maas ◽

Lucy C. Chappell ◽

Jessica E. Potts ◽

...

Keyword(s):

Temporal Changes ◽

Obstetric Outcomes ◽

Hypertensive Disorders

The Clinical Usefulness of Novel Prognostic Factors in CLL: A Study of 477 Patients with Low-Risk (Non-11q, Non-17p) FISH and Known IGVH Mutation Status.

Blood ◽

10.1182/blood.v110.11.3079.3079 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3079-3079 ◽

Cited By ~ 1

Author(s):

Constantine S. Tam ◽

Michael J. Keating ◽

Apostolia M. Tsimberidou ◽

Susan O’Brien ◽

Alessandra Tsimberidou ◽

...

Keyword(s):

Prognostic Factors ◽

High Risk ◽

Hazard Ratio ◽

Low Risk ◽

P Value ◽

Mutation Status ◽

Trisomy 12 ◽

The Impact ◽

Standard Risk ◽

Active Disease

Abstract In order to develop integrated models utilizing commonly available prognostic factors, we studied the clinical signficance of IGVH mutation, CD38 and ZAP-70 in 477 CLL patients (pts) with low-risk (non-11q, non-17p) FISH findings. All pts were untreated at the time of FISH assessment, and were collected prospectively in the MD Anderson CLL database. Two hundred & fifteen pts (45%) had mono- (n=160) or bi-alleleic (n=55) deletion of 13q {DEL13Q}, 162 pts (34%) had a negative FISH panel {NEG}, and 100 pts (21%) had trisomy 12 as sole FISH abnormality (n=78) or in association with deletion 13q (n=22) {T12}. Compared to other FISH groups, DEL13Q pts had lower B2m (median 2.2 v 2.6mg/L, p=0.01) and were less likely to be IGVH unmutated (33% v 48%, p=0.001). In contrast, T12 pts were more likely to present with advanced stage disease (Rai≥2 36% v 23%, p=0.01), be CD38 positive (44% v 13%, p<0.001), and have karyotypic abnormalities (48% v 7%, p<0.001). One hundred and twenty-three pts had active disease requiring immediate therapy and 354 pts had stable disease, of whom 291 were evaluable for disease progression. At a median follow-up of 20 months, 73 pts had developed active disease with NCI-WG indication(s) for treatment. Actuarial 2 year time to treatment (TTT) was 26%, with no significant difference between 13q, NEG and T12 pts (p=0.27). TTT was associated with elevated B2m (≥1.5ULN), IGVH mutation status and ZAP-70 in DEL13Q and NEG pts, but not in T12 patients (Table). For DEL13Q/NEG pts, a simple model using IGVH mutation and B2m separated high risk pts (unmutated or high B2m, 2yr TTT 43%) from standard risk pts (mutated and low B2m, 2yr TTT 11%, p<0.0001). For T12 pts, a model based on CD38 positivity and karyotypic abnormalities separated high risk pts (2 factors, 2yr TTT 75%) from standard risk pts (0 or 1 factor, 2yr TTT 15%, p=0.008). These results show that the impact of prognostic factors on TTT is dependent on the underlying FISH karyotype, and underscores the need for future studies in CLL prognostic factors to take into account the complete risk profile of the pt. NEGATIVE FISH DELETION 13Q TRISOMY 12 p-value hazard ratio p-value hazard ratio p-value hazard ratio IGVH Mutation <0.001 8.0 0.003 2.9 0.97 0.98 B2m ≥1.5ULN <0.001 4.5 0.07 2.2 0.54 0.68 CD38 Positivity 0.05 2.5 0.05 2.4 0.06 7.4 Abn Cytogenetics <0.001 11.0 0.27 2.2 0.09 2.8 ZAP-70 0.02 2.9 0.007 3.1 0.70 1.3 Figure Figure Figure Figure

The Impact of Extreme Maternal Ages on Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study in Dakar, Senegal

Open Journal of Obstetrics and Gynecology ◽

10.4236/ojog.2020.1020018 ◽

2020 ◽

Vol 10 (02) ◽

pp. 213-220

Author(s):

Mame Diarra Ndiaye ◽

Mamour Gueye ◽

Moussa Diallo ◽

Mouhamadou Wade ◽

Abdoulaye Diakhate ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hypertensive Disorders ◽

Study of the serum uric acid level as a prognostic indicator in hypertensive disorders of pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20213466 ◽

2021 ◽

Vol 10 (9) ◽

pp. 3441

Author(s):

Smitha Krishnegowda ◽

G. Nita

Keyword(s):

Uric Acid ◽

Disease Severity ◽

Serum Uric Acid ◽

Mode Of Delivery ◽

Prognostic Indicator ◽

Maternal Serum ◽

P Value ◽

Chronic Hypertension ◽

Hypertensive Disorders

Background: Abnormal uric acid levels in patients with preeclampsia and eclampsia affect both maternal and fetal outcome negatively. This study was done to know the alterations in these serum levels in comparison to normal pregnancy and also among various hypertensive disorders of pregnancies.Methods: Maternal serum uric acid levels were compared among cases and controls in relation to disease severity, mode of delivery, maternal outcome.Results: In group A (cases), 10 patients had raised uric acid levels, of which 5 were severe preeclampsia, 3 were eclampsia and 2 cases of chronic hypertension superimposed preeclampsia. P value is 0.001 (highly significant). Also serum uric acid is significantly elevated in hypertensive disorders of pregnancy compared with controls with a P value of 0.001.Conclusions: Significant correlation was observed between maternal serum uric acid, disease severity and maternal outcome. Our study concludes that uric acid can be considered as a sensitive prognostic indicator of severity in hypertensive disorders of pregnancy.