Original Research Article

Study of fetomaternal outcome in patients with

pregnancy induced hypertension at Sangli
district
Sudhir Gavali1, Anita Patil2*, Ujwalla Gavali3
{1,2Assistant Professor, Department of Obstetrics and Gynaecology} { 3Associate Professor, Department of Pediatrics}
Prakash Institute of Medical Science & Research, Islampur INDIA.
Email: kishkita@rediffmail.com
Abstract Background: Despite advances in medicine, Pregnancy Induced Hypertension continues to remain a leading cause of
maternal and perinatal mortality and morbidity throughout the world. As effective treatments are currently limited,
prevention and identification of the causes and risk factors are of importance. Present study is aimed to estimate risk factors,
and maternal and fetal outcomes in pregnant women with pregnancy induced hypertension at maternity hospitals in Sangli
District. Material and Methods: Present study was multicenter, prospective observational study, conducted in pregnant
women with more than 20 weeks gestational age with BP recording of >140/90 mm Hg with traces or 1+ or more
albuminuria was the criteria followed for categorising Gestational hypertension, pre-eclampsia and severe pre-eclampsia
as per the guidelines of AICOG. Results: After applying inclusion and exclusion criteria, total 216 patients were considered
for present study, incidence was 7.28 %. Most common characteristics were age below 25 years (51.32 %), 33-36 weeks
gestational age at time of diagnosis (41.2 %) and nullipara patients (48.15 %). In present study at time of initial diagnosis,
incidence of pregnancy induced hypertension was gestational hypertension (42.13 %), non-severe preeclampsia (30.56 %),
severe preeclampsia (19.44 %) and eclampsia (7.87 %). Particularly gestational hypertension patients progressed to
preeclampsia group and 4 cases of preeclampsia had postpartum convulsions. Majority of patients were delivered by vaginal
route (66.20 %). Other modes of delivery were emergency LSCS (19.91 %), elective LSCS (7.87 %), vacuum delivery
(4.17 %) and forceps delivery (1.85 %) In present study Maternal complications observed were eclampsia (9.72 %),
postpartum haemorrhage (8.80 %), abruptio placentae (7.87 %), partial HELLP (6.94 %). 5cases had severe eclampsia and
DIC. Majority of neonates had birth weight > 2500 grams (72.59 %) and ≥8 APGAR score at 5 minutes after birth (90.24
%). Neonatal complications observed were IUGR (7.41 %), Prematurity (14.81 %), Low birth weight babies (17.13 %),
respiratory distress syndrome (9.72 %), Meconium aspiration (6.02 %) and NICU admission (20.83 %). Neonatal outcome
noted was intrauterine death (1.85 %), still birth (3.24 %), neonatal death (3.24 %) and rest of neonates were discharged
with mother. Conclusion: Preeclampsia and eclampsia continue to be significant causes of maternal and fetal morbidity
and mortality.
Keywords: Preeclampsia, eclampsia, pregnancy induced hypertension, maternal morbidity
*
Address for Correspondence:
Dr Anita Patil, Assistant Professor, Department of Obstetrics and Gynaecology, Prakash Institute of Medical Science & Research, Islampur
INDIA.
Email: kishkita@rediffmail.com
Received Date: 26/07/2021 Revised Date: 12/08/2021 Accepted Date: 04/09/2021
DOI: https://doi.org/10.26611/10122025
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Access this article online INTRODUCTION

Despite advances in medicine, pregnancy induced
Quick Response Code: hypertension continues to remain leading cause of
Website: maternal and perinatal mortality and morbidity throughout
www.medpulse.in the world. Predicting the onset of these complications,
could aid in timely interventions such as increased
surveillance, treatment of symptoms, transfer to higher
Accessed Date: care facility and delivery, when necessary, which could
reduce morbidity and mortality from the pregnancy
10 November 2021 induced hypertension.1,2 Maternal complications noted in

How to cite this article: Sudhir Gavali, Anita Patil, Ujwalla Gavali. Study of fetomaternal outcome in patients with pregnancy induced
hypertension at Sangli district. MedPulse International Journal of Gynaecology. November 2021; 20(2): 65-69.
http://medpulse.in/Gynacology/index.php
 MedPulse International Journal of Gynaecology, Print ISSN: 2579-0870, Online ISSN: 2636-4719, Volume 20, Issue 2, November 2021 pp 65-69

cases of pregnancy induced hypertension are HELLP Exclusion criteria: Patients with chronic hypertension
syndrome, temporary blindness, abruptio placentae, before 20 weeks of gestation, chronic renal disease,
disseminated intravascular coagulation (DIC), acute renal connective tissue. Patient lost to follow up, not completed
failure (ARF), pulmonary oedema, arrhythmias, liver follow up till 6 weeks postpartum.
lesions, intracranial or hepatic hemorrhage, adult A written informed consent for participation in present
respiratory distress syndrome (ARDS), hypervolemia and study obtained from the patient. Pregnant women
risk of recurrent preeclampsia.3 The most common diagnosed with pregnancy induced hypertension were
consequences associated with pregnancy induced admitted for evaluation. Details such as maternal age,
hypertension are intra-uterine fetal growth retardation parity, booking status, gestational age at diagnosis,
(IUGR), intrauterine fetal demise, prematurity and low examination findings, radiological and laboratory
birth weight. Pregnancy induced hypertension predisposes investigations were noted. Investigations such as bedside
women to acute and chronic utero-placental insufficiency urine protein estimation, complete blood count, platelet
resulting in ante or intrapartum anoxia that may lead to count, coagulation profile, renal function tests, liver
fetal death, IUGR and preterm delivery.4 As effective function tests were done in all patients. Ultrasonography
treatments are currently limited, prevention and with Doppler was done after stabilising the condition of the
identification of the causes and risk factors are of patients in selected cases. Pregnant women were managed
importance. Present study aimed to estimate risk factors, in accordance with the standardised department protocol.
and maternal and fetal outcomes in pregnant women with Tab labetalol and Tab nifedipine were used for control and
pregnancy induced hypertension at maternity hospitals in prevention of hypertension. The aim is to keep the diastolic
Sangli District. blood pressure between 90 and 100 mmHg. follow up was
kept continuously. During follow up visits, time and mode
MATERIAL AND METHODS of delivery was decided depending upon favourability of
Present study was multi-center, prospective observational the cervix, gestational age, previous obstetric history, etc.
study, conducted in Department of Obstetrics and by senior obstetrician. Intrapartum events were monitored
Gynecology, at Prakash Institute of Medical Sciences and with help of partograph. Details such as mode of delivery,
Research, Sangli District Maharashtra, India. Study was treatment given, complications- (both maternal and foetal)
conducted between March 2021 to August 2021. and finally the maternal and fetal outcome was noted. The
Institutional ethical committee approval was taken for patients were then subsequently followed up till discharge
present study. from the hospital. Statistical analysis was done using
Inclusion criteria: All pregnant women with more than 20 descriptive statistics.
weeks gestational age with BP recording of >140/90 mm
Hg with traces or 1+ or more albuminuria was the criteria RESULTS
followed for categorising Gestational hypertension, pre- After applying inclusion and exclusion criteria, total 216
eclampsia and severe preeclampsia as per guidelines of patients were considered for present study, incidence was
AICOG.5 Patients diagnosed and later delivered at 7.28 %. Most common characteristics were age below 25
maternity hospitals and follow up kept till 6 weeks years (51.32 %), 33-36 weeks gestational age at time of
postpartum. diagnosis (41.2 %) and nullipara patients (48.15 %).
Table 1: maternal characteristics
Characteristics No of patients Percentage
Maternal age
≤20 years 37 17.13
21-25 years 76 35.19
26-30 years 69 31.94
31-35 years 23 10.65
≥35 years 11 5.09
Gestational age at time of diagnosis 0.00
≤ 28 weeks 18 8.33
29-32 weeks 40 18.52
33-36 weeks 89 41.20
≥37 weeks 69 31.94
Parity 0.00
0 104 48.15
1–2 80 37.04
3 or more 32 14.81

MedPulse International Journal of Gynaecology, Print ISSN: 2579-0870, Online ISSN: 2636-4719, Volume 20, Issue 2, November 2021 Page 66
 Sudhir Gavali, Anita Patil, Ujwalla Gavali

In present study at time of initial diagnosis, incidence of gestational hypertension, non-severe preeclampsia, severe
preeclampsia and eclampsia was noted as 42.13 %, 30.56 %), 19.44 % and eclampsia 7.87 % respectively. Incidence of
pregnancy induced hypertension patients changed 24 hours after delivery as gestational hypertension (28.7 %), non-severe
preeclampsia (37.5 %), severe preeclampsia (24.07 %) and eclampsia (9.72 %). Particularly gestational hypertension
patients progressed to preeclampsia group and 4 cases of preeclampsia had postpartum convulsions.

Table 2: Different types of pregnancy induced hypertension (n=216).

Types of pregnancy At time of initial diagnosis After 24 hours of delivery
induced hypertension No of cases (n) Percentage No of cases (n) Percentage
Gestational hypertension 91 42.13 62 28.70
Non-severe Preeclampsia 66 30.56 81 37.50
Severe preeclampsia 42 19.44 52 24.07
Eclampsia 17 7.87 21 9.72
Majority of patients were delivered by vaginal route (66.20 %). Other modes of delivery were emergency LSCS (19.91
%), elective LSCS (7.87 %), vacuum delivery (4.17 %) and forceps delivery (1.85 %).

Table 3: Mode of delivery

Mode of delivery No. of cases %
Vaginal 143 66.20
LSCS - Emergency 43 19.91
LSCS – Elective 17 7.87
Instrumental – vacuum 9 4.17
Instrumental – forceps 4 1.85
In present study Maternal complications observed were eclampsia (9.72 %), postpartum haemorrhage (8.80 %), abruptio
placentae (7.87 %), partial HELLP (6.94 %), HELLP (1.39 %), renal dysfunction (2.78 %), DIC (2.32 %) and pulmonary
oedema (0.93 %).

Table 4: Maternal complications

Complication No. of cases %
Eclampsia 21 9.72
PPH 19 8.80
Abruptio placentae 17 7.87
Partial HELLP 15 6.94
Renal dysfunction 6 2.78
HELLP 3 1.39
DIC 5 2.32
Pulmonary oedema 2 0.93
Majority of neonates had birth weight > 2500 grams (72.59 %) and ≥8 APGAR score at 5 minutes after birth
(90.24 %). Neonatal complications observed were IUGR (7.41 %), Prematurity (14.81 %), Low birth weight babies (17.13
%), respiratory distress syndrome (9.72 %), Meconium aspiration (6.02 %) and NICU admission (20.83 %). Neonatal
outcome noted was intrauterine death (1.85 %), still birth (3.24 %), neonatal death (3.24 %) and rest of neonates were
discharged with mother.

Table 5: Perinatal outcome in eclamptic patients

Neonatal characteristics No of patients Percentage
Birth weight (grams)
≤1000 3 1.39
1001-1500 11 5.09
1501-2500 45 20.83
>2500 157 72.69
Apgar score at 5 minutes
1-2 7 3.41
3-7 13 6.34
≥8 185 90.24
Neonatal outcome 0.00
IUGR 16 7.41

Copyright © 2021, Medpulse Publishing Corporation, MedPulse International Journal of Gynaecology, Volume 20, Issue 2 November 2021
 MedPulse International Journal of Gynaecology, Print ISSN: 2579-0870, Online ISSN: 2636-4719, Volume 20, Issue 2, November 2021 pp 65-69

Prematurity 32 14.81
Respiratory distress syndrome 21 9.72
Meconium aspiration 13 6.02
Intrauterine death 4 1.85
Still birth 7 3.24
NICU admission 45 20.83
Low birth weight babies 37 17.13
Neonatal death 7 3.24

DISCUSSION whereas cesarean rate in mild pre-eclampsia group was

Out of the triad of infection, hemorrhage and hypertension, 7.2%. Prematurity (67.9%), perinatal mortality (12.5%),
which are the top causes of maternal morbidity and birth asphyxia (21.4%) of patients were noted. Partial
mortality, the first two have been controlled to a great HELLP and HELLP were seen in 37.5% of patients,
extent. Moreover, they are amendable to available eclampsia in 1.8% patients; other complications included
modalities of treatment. Only hypertensive disease of DIC and pulmonary edema which was seen in 3.6% of
pregnancy, as a group, remains difficult to prognosticate cases each and maternal mortality rate was 1.8%. Similar
and manage. The hypertensive disorder in pregnancy findings were noted in present study. In study by D. P.
includes chronic hypertension and the group of Meshram et al.,10 maternal complications were HELLP
hypertensive disorders unique to pregnancy including syndrome (10 %), PPH (8 %), infections (3 %), ascites (6
gestational hypertension, preeclampsia and eclampsia. The %), acute renal failure (2 %), disseminated intravascular
spectrum of pregnancy induced hypertension ranges from coagulation (DIC) (3 %), and maternal death (2 %). Fetal
mildly elevated blood pressures with minimal clinical complications included IUGR (18 %) and perinatal death
significance to severe hypertension with multi-organ (27 %). Out of 32 patients with deranged coagulation
dysfunction Maternal age is considered as a major risk profile, 84.37% women had adverse maternal outcome and
factor, commonly seen at extremes of common 93.75% had unfavorable fetal outcome. Kolluru V et al.,11
reproductive age. Young age at marriage which is noted incidence of pregnancy induced hypertension as
associated with low educational and economic standards 7.9% (234 cases) of the total deliveries; out of which
and consequently poor antenatal attendance which can be gestational hypertension, preeclampsia and eclampsia
a major confounder.6 In study by Chaitra S et al.,7 accounting for 2.1%, 4.9% and 0.9% of all deliveries.
prevalence of pregnancy induced hypertension was 8.8%. Commonest maternal complication was HELLP syndrome
Out of 286 hypertensive pregnant women 80.06% were (3.4%) and there was no maternal mortality. Total number
diagnosed as gestational hypertension, 14.68% as of preterm deliveries were 3.47% and perinatal mortality
preeclampsia, 2.09% as eclampsia and 2.79 % as chronic was seen in 23% cases. IUGR was the commonest fetal
hypertension. Maximum number of women was complication (33.4%). Hypertensive disorders of
nulliparous (46.85%) and 21-25 years was the dominant pregnancy are known to be associated with several
age group (46.15%). It is more prevalent at term (49.65%). perinatal complications which can be measured in terms of
27.97% had a vaginal delivery while 71.32% had a prevalence of preterm delivery, low birth weight, low
cesarean delivery. Preterm delivery was the most prevalent Apgar score, intrauterine growth restriction, the need for
morbid outcomes (28.67%). 26.57% of the babies were resuscitation and/or admission to a neonatal intensive care
low birth weight and 14.68% had intrauterine growth unit (NICU), and stillbirths. In study by Pandya K et al.,12
restriction. Similar findings were noted in presents study. gestational Hypertension was most common (65.62%),
In study by Tiwari A et al.,8 out of 180 cases of pregnancy followed by Preeclampsia (28.12%) and Eclampsia
induced hypertension, majority were of preeclampsia (6.25%). The most common fetal complications found
(47.22%), then Gestational hypertension 38.88%, were preterm births (43.75%) and LBW (37.5%). 28.12%
percentage of eclampsia (13.88%). Incidence of low birth babies required NICU admission due to various reasons
weight in PIH is 57.7%, preterm 44.2% and IUGR 20.4%, whereas 6.25% neonatal deaths were reported. Presently
Still birth 8 (4.4%), early neonatal death 22 (12.2%), screening modalities help early detection of the diseases
Highest incidence of LBW (88%), Preterm (80%), IUGR and timely intervention of hypertensive disorders
(12%) was present in eclampsia group. Singh A et al.,9 complicating pregnancy and provision of specialized
studied 224 patients, 40% were booked, 76.8% cases were systemic antenatal maternal care could reduce the impacts
of age group 21-30 years. About 58.9% of them were of such complications.
primigravida, 82.1% of presented at gestational age of ≥34
weeks and 5.4% were below 30 weeks About 14.2%
patients of severe pre-eclampsia were delivered by LSCS,

MedPulse International Journal of Gynaecology, Print ISSN: 2579-0870, Online ISSN: 2636-4719, Volume 20, Issue 2, November 2021 Page 68
 Sudhir Gavali, Anita Patil, Ujwalla Gavali

CONCLUSION 6. Abalos E, Cuesta C, Grosso AL, Chou D, Say L. Global

and regional estimates of preeclampsia and eclampsia: a
Preeclampsia and eclampsia continue to be significant
systematic review. Eur J Obstetrics Gynaecology
causes of maternal and fetal morbidity and mortality. The Reproductive Biology 2013;170(1):1–7.
adverse maternal and perinatal outcome can be reduced by 7. Chaitra S, Jayanthi, Seth AR, Ramaiah R, Kannan A,
regular antenatal checkups, early diagnosis, timely referral Mahantesh M. Outcome in hypertension complicating
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Source of Support: None Declared
Conflict of Interest: None Declared

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