Pattern and Factors Affecting the Outcome of Pregnancy: RESULTS

24 Jan
2010

There were 2,393 deliveries between January 1997 and December 2002, with 127 (5.30%) patients fulfilling the criteria for hypertensive disorder of pregnancy. The yearly breakdown from 1997 to 2002 is as follows 16/438 (36.5 per 1,000), 13/402 (32.3 per 1,000), 13/194 (67.0 per 1,000), 19/940 (20.2 per 1,000), 25/443 (56.4 per 1,000) and 41/476 (86.1 per 1,000), respectively. Out of the 127 patients, full records were available for study for 122 patients.

The mean age for the patients studied was 27.3 ± 6.0 years. Seventy (57.4%) were illiterate, and 56 (45.9%) were nulliparous. Sixty-six (51.4%) patients had eclampsia, six (2.5%) patients had abruptio, while five (4.1%) patients had stroke. Six (4.9%) patients had heart failure—mainly left ventricular failure—and there were eight (6.6%) maternal deaths. There were 46 (37.7%) fetal deaths (Table 1). tadacip 20

Table 1. General Characteristics of All Patients (n=122)

Variable

n(%)

Age (mean ± SD) years

27.3 ± 6.0

High risk

62 (50.8)

Low risk

60 (49.2)

Illiterate

70 (57.4)

Nullipara

56 (45.9)

Fetal death

46 (37.7)

Respiratory distress syndrome

62 (50.8)

Maternal death

8 (6.6)

Eclampsia

66 (54.1)

Target organ damage

18 (14.8)

Heart failure

6 (4.9)

Stroke

5(4.1)

Abruptio

6 (4.9)

There were 32 (26.2%) patients with de novo (gestational) HTN, 24 (19.7%) with PET superimposed on chronic HTN and 66 (54.1%) with PET/eclampsia. All of the chronic hypertensive patients had superimposed PET or eclampsia, so there was no distinct chronic HTN group. The mean duration of prepregnancy HTN in the chronic HTN group was 2.50 ± 1.24 years.

Table 2. Characteristics of All Patients According to Group of Hypertensive Disorder of Pregnancy

De-Novo

PET on Chronic HTN

PET/

ANOVA

Gestational (N=32)

(N=24)

Eclampsia

(N=66)
Mean age (years ± SD)

28.4 ± 6.9

29.9 ± 4.6

25.8 ± 5.8

0.092
Mean SBP (mmHg ± SD)

160.19 127.04

165.00 ± 22.36

176.06 ±24.10

0.089
Mean DBP (mmHg ± SD)

110.671 15.80

110.83 120.65

115.30 ± 12.62

0.519
High risk (n%)

10 (31.3)

10 (41.7)

42 (63.6)

0.0006
Low risk (n%)

22 (68.8)

14 (58.3)

24 (36.4)

0.0006
Target organ damage (n%)

2 (6.3)

4 (16.7)

12 (18.2)

0.283
Maternal death (n%)

4(12.5)

0 (0.00)

4(6.1)

0.169
Abruptio (n%)

2 (6.3)

0 (0.00)

4(6.1)

0.461
Eclampsia (n%)

0 (0.00)

14 (58.3)

52 (78.8)

0.00001
Fetal respiratory distress (n%)

12 (37.5)

6 (25.0)

44 (66.7)

0.00047
Mean birthweight (kg ± SD)

2.83 ± 0.78

2.61 ±0.79

2.74 ± 0.63

0.767
Mean gestational age (weeks ± SD)

35.6 ± 3.7

34.4 ± 3.6

34.8 ± 3.6

0.698
Fetal death (n%)

12 (37.5)

10 (41.7)

24 (36.4)

0.899

The group with PET/eclampsia tended to be younger (25.8 ± 5.8 vs. 29.9 ± 4.6, p=0.092) and appeared to have higher systolic BPs (176.06 + 24.10 vs. 160.19 + 27.04, p=0.089), though not statistically significant. There was no significant difference in the diastolic pressures of the three groups (Table 2). The PET/eclampsia group also belonged more to the higher-risk group (63.6 vs. 31.3, p=0.0006), while the patients with gestational HTN belonged more to the low-risk group (68.8 vs. 36.4, p=0.0006). There was no difference in the mean birthweight, the mean gestational age and fetal death rate for all the groups. By definition, all the groups were associated with preterm birth, the mean gestational age for all the groups was less than 36 weeks and all the groups had mean birthweight less than 3.2 kg denoting small-for-date babies. The PET/ eclampsia group when compared to gestational HTN had more fetal respiratory syndrome (66.7% vs. 37.5%, p=0.00047) and eclampsia (78.8% vs. 58.3%, p=0.0001). There was no significant difference in maternal death between the two groups (12.5% vs. 6.1%, p=0.169).No maternal death was recorded in the PET on chronic group, though when compared to the other groups, this also did not reach statistical significance. canadian antibiotics

Table 3. Effects of Risk Stratification on Maternal and Fetal Outcome

High Risk (N=62)

Low Risk (N=60)

P Value
Mean age (years ± SD)25.90 ± 5.52

28.73 ± 6.32

0.067
Illiterate (n%)42 (67.7)

28 (46.7)

0.018
Literate (n%)20 (32.3)

32 (53.3)

0.018
Parity (n%)
030 (51.6)

26 (43.3)

0.575
1-322 (35.5)

24 (40.0)

0.607
>310 (16.1)

10 (16.7)

0.936
ANC
Poor (<25%)24 (38.7)

20 (33.3)

0.536
Fair (25-75%)24 (38.7)

20 (33.3)

0.536
Regular (>75%)14(22.6)

20 (33.3)

0.185
Maternal death (n%)6 (9.7)

2 (3.3)

0.157
Heart failure (n%)2 (3.2)

4 (6.6)

0.646
Stroke (n%)5(8.1)

0 (0.0)

0.436
Abruptio (n%)4 (6.5)

2 (3.3)

0.705
Gestational age (weeks ± SD)34.4 ± 3.7

35.5 ± 3.4

0.299
Mode of delivery (n%)
SVD22 (35.5)

30 (50.0)

0.105
Assisted8 (12.9)

2 (3.3)

0.110
Emc/s28 (45.2)

18 (30.0)

0.08
Elc/s2 (3.2)

4 (6.6)

0.645
Induction2 (3.2)

4 (6.6)

0.294
Birthweight (kg ± SD)2.56 ± 0.69

2.93 ± 0.65

0.042
Fetal death (n%)30 (48.9)

16 (26.7)

0.052
Fetal respiratory distress (n%)36 (58.1)

26 (43.3)

0.104

Sixty-two (50.8%) of all the patients were high risk, while 60 (49.2%) were low-risk (Table 3). There was no difference in the mean ages of high-risk and low-risk groups (Table 3). More patients in the high-risk group tend to be illiterate, attended ANC less regularly and had more maternal deaths. All the five patients who had stroke were in the high-risk group, and 67% of all the patients with abruptio also belonged to this group. There were more fetal deaths [30 (48.3%) vs. 16 (26.7%), p<0.05]. There were more assisted and emergency deliveries and fetal respiratory distress in the high-risk group, though none of these variables reached statistical significance. Babies in the low-risk group tended to be bigger (2.56 ± 0.69 vs. 2.93 ± 0.65 kg, p=0.042). tadalis sx 20

Table 4. Pattern of Target Organ Damage According to Groups of Hypertensive Disorders of Pregnancy

De-Novo

PET on Chronic HTN

PET/Eclampsia

Gestational (N=32)

(N=24)

(N=66)

Angina/myocardial infarction (n%)

0 (0.0)

2 (8.33)

0 (0.0)

Cerebrovascular accident (n%)

0 (0.0)

0 (0.0)

5 (7.56)

Creatinine >1.5mg% (n%)

0 (0.0)

0 (0.0)

5 (7.56)

Heart failure (n%)

2 (6.25)

2 (8.33)

2 (3.03)

Table 4 showed the pattern of target organ damage according to the groups. In general, there were more end organ effects in the group with PET/ eclampsia. Only one of five (20%) patients who were referred to the medical outpatient HTN clinic reported for assessment.

When logistic regression was used, though statis tically not significant, the trend observed was that the older the patient (OR=0.3618, 95% CI 0.1224-1.0700, P=0.66) and the more literate the patient (OR=0.4167, 95% CI 0.1472-1.1789 P=0.99), the less likely for them to be in the high-risk group. The parity of the patient also had no effect with whether she belonged to the high- or low-risk group (OR=0.7944, 95% CI 0.2631-2.399, p=0.99). Similarly, regular ANC attendance appears to reduce the likelihood that a patient belongs to the high-risk group (OR=0.58, 95% CI 0.162-2.097, P=0.409). There appears to be at least twice the risk of developing eclampsia (OR=2.3777, 95% CI 0.8480-6.6659, P=0.100); and abruptio (OR=2.00, 95% CI 0.1717-23.2933, P=0.580) in patients who belonged to the high-risk group. All of the five patients who had a cerebrovascular accident (stroke) belonged to the high-risk group. High-risk patients also seem to be at least three times likely to die (OR=3.1071, 95% CI 0.3047-31.68, P=0.339); though not necessarily from heart failure (OR=0.4667, 95% CI 0.4000-5.435, P=0.543). Furthermore, though not significant, patients in the high-risk group were five times more likely to have assisted delivery (OR=5.2, 95% CI 0.5002-54.05, P=0.168) and at least two times more likely to have emergency caesarean operative delivery (OR=2.022, 95% CI 0.6244-6.548, P=0.240).
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It is noteworthy that most of the confidence intervals crossed the null value, indicating that these associations were not statistically significant and with their wide ranges suggestive of the effect of small sample size and, consequently, low power of the study.

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