European Journal of Cardiovascular Medicine

Preeclampsia, also referred to as toxemia, is a type of high blood pressure that occurs during pregnancy. Pregnancy-related PIH is the second most frequent medical condition. Six to eight percent of pregnancies result in hypertensive problems; the percentage varies greatly depending on the location.¹ While the exact etiology of postpartum hemorrhage (PIH) is unknown, there are known risk factors for the condition, such as young women conceiving their first child, pregnant women under the age of 20, pregnant women over the age of 40, diabetes, pre-existing hypertension, history of PIH, etc.

They significantly increase maternal morbidity and death, along with bleeding and infection.² Oedema, hypertension, and proteinuria start to appear in patients with pregnancy-specific PIH, a multisystem illness that develops after 20 weeks of gestation.³ According to estimates from the World Health Organization, complications from hypertensive diseases during pregnancy claim the lives of at least one woman every seven minutes.⁴ A higher risk of unfavorable fetal, neonatal, and maternal outcomes—such as preterm delivery, intrauterine growth retardation (IUGR), perinatal death, antepartum hemorrhage, postpartum hemorrhage, and mother death—is linked to pregnancies complicated by hypertension diseases.^5,6

Not hypertension per se, but its consequences account for the majority of deaths in patients with PIH. Pregnancy-related severe toxaemia and eclampsia are now mainly prevented in large cities thanks to the introduction of prenatal care. However, it remains a serious obstetric issue in developing nations.⁷ Thus, we can reduce the maternal mortality by prevention and proper management of these complications.

Hence, the present study was conducted to find out incidence of PIH in a tertiary care hospital and foeto-maternal complications and outcomes associated with it

Type of study : Present study was institutional based prospective observational study.

Place of study : Department of Gynaecology and Obstetrics, Burdwan Medical College and Hospital, West Bengal, India

Time of study : The study started with the submission of research proposal. After receiving the clearance from the ethical committee study was conducted within 6 months period (March 2023 to August 2023).

Study Population : A total 100 pregnant women who presented to our Hospital with pregnancy induced hypertension during the study period were enrolled for the study with following inclusion and exclusion criteria.

Inclusion criteria : Women with 20 weeks of gestation and those who willing to participate in this study.  

Exclusion criteria : Those pregnant mother having chronic hypertension and those who not willing to participate in this study. 

PIH was diagnosed when the systolic blood pressure was ³140 mmHg and/or diastolic blood pressure ³90 mmHg measured on two occasions i.e. 4-6 hours apart and beyond 20 weeks of pregnancy (Includes all cases of mild and severe preeclampsia and eclampsia).

Classification of pregnant women into mild and sever hypertensive disorders of pregnancy as per guidelines mentioned in Dutta DC. Text Book of Obstetrics. 4th edition (mild PIH (140/90 to 159/109 mmHg) and severe PIH (160/110 mmHg or higher).⁸

Data Analysis plan- The data were entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Two-sample t-tests for a difference in mean involved independent samples or unpaired samples. Paired t-tests were a form of blocking and had greater power than unpaired tests. P-value ≤ 0.05 was considered for statistically significant.

Ethical considerations- Study was initiated after obtaining the informed consents from the participants and ethical clearance from the institutional ethical committee.

Table 1: Demographic profile of PIH patients. (n=100)

In present study higher percentage of PIH was noted among 18-22 years of age group 44 (44%) followed by 23-27 years of age group 28 (28%) and 28-32 years of age group 16 (16%). Majority of patients participated in study were Hindu 84 (84%) and residing in Rural area 64 (64%). (Table 1).

Table 2: Distribution of PIH patient as per obstetric history (n=100).

Table 2 shows that pregnancy induced hypertension was more prevalent among Nulliparous (62%). 56 (56%) women were primigravida and 44 (44%) were multigravida. Out of 40 women 18 (18%) have past h/o of PIH, 7 (7%) had previous preterm delivery and 12 (12%) had previous LSCS. In clinical presentation in mother with PIH it was found that 44 (44%) had lower abdominal pain, 22 (22%) had vomiting and epigastric discomfort followed by headache 24 (24%), convulsion 16 (16%).

Table 3: Distribution of PIH patients as per their blood pressure.

Out of 100 PIH patients 74% and 96% of had mild PIH with systolic blood pressure 140-160 mmHg and diastolic blood pressure 90-110 mmHg respectively. While 26% had sever PIH with systolic blood pressure more than 160 mmHg (Table 3).

Table 4: Foetal outcome in patients with PIH (n=100).

In the present study out of 100 PIH mother 62 (62%) had preterm delivery, 6 (6%) had post term delivery. 48 (48%) of babies are low birth weight, 8 (8%) are IUGR. Out of 100 deliveries 22 (22%) of babies were required NICU admission for various causes. 3 (3%) were IUFD and 2 (2%) of neonatal death. (Table 4)

Figure 1 : Distribution of PIH patients as per medication received.

In our study out of 100 PIH patients 78 (78%) received only antihypertensive medication while 14 (14%) of patients received both antihypertensive and anticonvulsant medication. Only 8 (8%) does not received any medication for PIH during present pregnancy. (Figure 1)

In present study higher percentage of PIH was noted among 18-22 years of age group 44 (44%) followed by 23-27 years of age group 28 (28%) and 28-32 years of age group 16 (16%). Majority of patients participated in study were Hindu 84 (84%) and residing in Rural area 64 (64%).

According to a study by Parmar et al. at NHL Municipal College in Ahmadabad, Gujarat, PIH is more common in expectant mothers between the ages of 21 and 30 (47.0%) and younger than 20 (53.1%.⁹ In their study, Gandhi et al. discovered that 48.42% of PIH mothers were between the ages of 21 and 25, followed by those over 30 (25.26%), 26–30 years old (14.73%), and under 20 years old (11.57%).¹⁰ In a similar vein, Bangal et al. discovered in their study that the majority of PIH mothers were between the ages of 15-20 (52.63%), followed by 21–25 (31.59%), 26–30 (10.52%), and over 30 (5.26%).¹¹ Khosravi et al. also reported that 55.6% of PIH mothers were between the ages of 21 and 30. These were followed by those who were older than 30 (32.2%) and younger than 20 (12.2%).¹²

In our study pregnancy induced hypertension was more prevalent among nulliparous (62%) as compared to  multiparous (38%). Parmar et al. found a similar thing in their study at NHL Municipal College, Ahmadabad, wherein 55.0% of the participants were in Primipara compared to 45.0% in Multipara.⁹ In contrast, a different study by Gandhi et al. and Khosravi et al. found that 43.15 percent of primiparous mothers and 56.85% of multiparous mothers were nullipara, while 32.8% of PIH mothers and 67.2% of multipara mothers were, respectively.^10,12

In our study among PIH mother we found that 18 (18%) have past h/o of PIH, 7 (7%) had previous preterm delivery and 12 (12%) had previous LSCS. In clinical presentation in mother with PIH it was found that 44 (44%) had lower abdominal pain, 22 (22%) had vomiting and epigastric discomfort followed by headache 24 (24%), convulsion 16 (16%).  Gandhi et al.'s study in Dharpur, Patan, revealed very identical results: 48.4% of participants experienced labor pain, 11.6% had convulsions, 10.5% had no complaints, 9.5% had oedema feet, and 6.3% had headaches and vaginal hemorrhage.¹⁰

In the present study out of 100 PIH patients 74% and 96% of had mild PIH with systolic blood pressure 140-160 mmHg and diastolic blood pressure 90-110 mmHg respectively. While 26% had sever PIH with systolic blood pressure more than 160 mmHg.

In their study, Khosravi et al. found that 61.1% of PIH mothers had 90-110 mmHg of DPB and 96.3% of mothers had 140-190 mmHg of SBP. 38.9% of mothers had DPB greater than 110 mmHg, while 3.7% of mothers had SBP greater than 190 mmHg.¹²

In our study among PIH mother out of 100 PIH patients 78 (78%) received only antihypertensive medication while 14 (14%) of patients received both antihypertensive and anticonvulsant medication. Only 8 (8%) does not received any medication for PIH during present pregnancy. 66.07% of PIH women received antihypertensive drugs, such as methyledopa or nifedipine, according to a study by Monica Muti et al., while 33.93% of PIH women did not receive any medication and were solely bedridden.¹³ A study carried out at Bharati Hospital in Pune revealed that 70 patients (67.31%) received treatment with antihypertensive drug combinations, while 34 patients (32.69%) received treatment with a single antihypertensive medication.¹⁴

The most frequent medical condition that arises during pregnancy is hypertension, which continues to be a major contributor to the morbidity and death of both the mother and the fetus.¹⁵ It makes about 10% of pregnancies more difficult.¹⁶

An increased risk of unfavorable fetal, neonatal, and maternal outcomes—such as preterm birth, intrauterine growth restriction (IUGR), perinatal death, acute renal or hepatic failure, antepartum hemorrhage, postpartum hemorrhage, and maternal death—is linked to pregnancies complicated by hypertension.¹⁷ One of the main causes of maternal morbidity and mortality, accounting for 10-15% of maternal fatalities, particularly in underdeveloped nations, is hypertensive disorders during pregnanc.¹⁸ About 3–10% of pregnancies may become complicated by it; the prevalence varies among hospitals and nations.¹⁹

In present study 62 (62%) had preterm delivery, 6 (6%) had post term delivery. 48 (48%) of babies are low birth weight, 8 (8%) are IUGR. Out of 100 deliveries 22 (22%) of babies were required NICU admission for various causes. 3 (3%) were IUFD and 2 (2%) of neonatal death.

In the Karl Referral Hospital in Ethiopia, Seyom et al.'s study on the effects of pregnancy-related hypertension on the mother and the fetus revealed a low birth weight rate of 30.5%, an abortion rate of 10.7%, a stillbirth rate of 10.2%, and a preterm delivery rate of 31.4%.²⁰

According to Jiji, 38.0% of infants were IUGR and 40.0% of newborns had low birth weights.²¹ Bangal In their study, out of 100 PIH mothers, 19.0% had IUGR, 17.0% had IUFD, and 5.0% had neonatal death in a rural tertiary level health care referral center in Loni, Maharashtra.¹¹ Ahmed According to a study conducted at Grant Medical College and the Sir J. J. Group of Hospitals in Mumbai, out of 250 deliveries made by PIH mothers, 72 (28.8%) of the babies had birth weights under 2 kg, and 69 (27.61%) of them needed to be admitted to the NICU.²²

One prevalent medical condition linked to pregnancy is pregnancy-induced hypertension. We observed that nulliparous moms and younger age groups are more likely to experience PIH. PIH can have a variety of clinical manifestations, some of which can be used to identify the condition early. PIH also increases the risk of unfavorable fetal outcomes. Therefore, early identification and institutional management of PIH patients can reduce fetal morbidity and mortality.

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