Fetal and maternal outcome in pregnancy induced hypertension in Sri Lanka

Bhagya Kasun, Fathima Isuru, R

Abstract

The identification of this clinical entity and effective management play a significant role in the outcome of pregnancy, both for the mother and the fetus hence reducing maternal and perinatal mortality. To determine the Fetal and Maternal outcome in Pregnancy Induced Hypertension compared with matched normal controls specifically with regard to age, common symptoms, signs, amniotic fluid index, Doppler, delivery details and neonatal outcome. A retrospective case control study was conducted for one year period (2007/01 to 2008/01) and relevant information were obtained from consecutive consenting mothers who were admitted and managed at ward 03 and ward 15. Measurement of blood pressure was standardized and matched with a controlled group.Statistical analysis was performed with chi-square test, regression analysis and McNemar test within the Statistical Package For Social Sciences Software. The age of mothers ranged from 16 to 40 years. The mean age was 30.1 years (SD = 4.9 years). The highest proportion (35.6%) of mothers was in 31 –35 year age group. The smallest proportion (4.0%) of mothers were in 16 – 20 year age group. Majority (38.6%) of the mothers were primigravidae. Of the hypertensives 50.5% had BMI over 25 kg/m 2. The majority (66.3%) of the patients have developed PIH between 33 weeks to 37+6 weeks. The occurrence of late hypertension is significant with a correlation coefficient (r) of = 0.45, p<0.001.) Nearly 20% of the cases were asymptomatic. The occurrence of classical symptoms like headache, oedema, visual disturbances and epigastric pain were very significant (p< 0.001) among the severe hypertensives. There was no significant relationship between the AFI and EFW in both groups of mothers before 38 weeks of gestation (r = 0.43 P = 0.16, r = 0.35, P = 0.09). There was a significant relationship between the AFI and EFW after 38 weeks’ gestation (r = 0.61; P = 0.03). A positive relationship between the AFI and EFW was noted late in gestation. There were significant abnormalities in the Doppler indices seen in PIH (p <0.01) although the sample was too small. The identification of this clinical entity and effective management play a significant role in the outcome of pregnancy, both for the mother and the fetus hence reducing maternal and perinatal mortality.