Hypertensive disorders of pregnancy: frequency, maternal and fetal outcomes

To determine the frequency and distribution of different types of hypertensive disorders of pregnancy and to determine the impact of hypertensive disorders of pregnancy [HDP] on maternal and fetal outcomes. A descriptive retrospective study. The study was conducted in the department of Gynaecology and Obstetric of Isra University Hospital Hyderabad from January to December 2007. All the patients who were diagnosed to have hypertensive disorders of pregnancy during study period were categorized as group I. One hundred nineteen women delivered during the same period without hypertensive disorders of pregnancy were included as group II. The data regarding demographic and obstetrical parameters, associated risk factors, fetal and maternal complications were gathered from available data on medical record files. Total number of deliveries during the same period was obtained. Frequency of hypertensive disorders of pregnancy was calculated. Statistical analysis was performed by SPSS V11. Pearson's chi square and student's t test was used for comparison of variables in between two groups. P value < 0.05 was considered significant. The frequency of Hypertensive disorders of pregnancy was 8.9% in our study. The mean maternal age was 28.57 +/- 5.8 years and 26.56 +/- 5.0 years for group I and II respectively. Forty eight [76.2%] of group I patients were Unbooked for antenatal care, 37[58.7%] belonged to poor socioeconomic status and 82[45.1%] were multipara. Statistically significant difference was found for antenatal booking status [P. 0.04] and socioeconomic status [P. 0.01] and parity [P 0.04] in both groups. Twenty three [36.5%] patients from group I had past history of hypertensive disorders of pregnancy, while it was reported only by 8[6.7%] of group II patients. It was observed that women with HDP have strong family history of hypertension [P. <0.001]. Regarding maternal outcome more patients from group I were shifted to ICU as compared to group II. Maternal mortality was significantly high in group I [P <0.001]. The mean gestational age was 35.29 +/- 2.6 weeks and 38.03 +/- 1.3 weeks in group I and II respectively. The mean birth weight of baby was 2.5 +/- 0.73 kilograms and 2.8 +/- 0.41kilograms in group I and II respectively. Statistically significant difference was observed in both groups for mean gestational age [P<0.001] and mean birth weight of baby [P<0.001]. Statistically significant difference was observed for Preterm birth, Still born, Neonatal death and admission of newborn in neonatal intensive care unit [P <0.001], [P <0.001], [P <0.001], [P<0.001] respectively. The Perinatal mortality was 230/1000 births in group I, while it was 40/1000 in group II. Frequency of HDP is high in our set up. It is associated with high maternal and perinatal morbidity and mortality

Comparison of intravenous hydralazine - bolus dose versus continuous infusion drip in eclampsia

The leading cause of maternal death from eclampsia is cerebral hemorrhage, which is presumably the consequence of severe hypertension, so the acute elevations in blood pressure above 160/100 mm Hg should be brought under control. A study of forty diagnosed cases of eclampsia was carried out in Lady Willingdon Hospital, Lahore to determine the time and quantity of drug required to control high blood pressure levels by intravenous hydralazine bolus dose versus continuous infusion drip. Patients were divided into control and case group. In control group continuous infusion was given and in cases bolus dose was given. Mean time taken to control blood pressure by continuous infusion was 124.75 minutes and drug quantity was 23.50 mg while it was 52 minutes and 12.25 mg in case of bolus method. The study showed that 60-70% less time was required and 37.5-50% less drug quantity was used in bolus method versus continuous infusion of intravenous hydralazine. Regarding efficacy of intravenous hydralazine, it was fou nd to be statistically superior in this study [P<0.05] so that management strategy should be changed in favour of bolus dose as compared to continuous infusion of intravenous hydralazine

Fetal cardiovascular hemodynamics in diabetic and hypertensive pregnancies

Fetal echocardiography is a useful technique in the evaluation of the fetal cardiovascular system. The purpose of this work was to evaluate fetal cardiac anatomy and function in two of the most common medical problems seen in pregnancy, diabetes mellitus and chronic maternal hypertension. In this cross sectional study, 60 fetuses between 20-30 weeks of gestation were included. Twenty of them were fetuses of diabetic mothers [FODMs], 20 fetuses of hypertensive mothers [FOHMs] and the remaining twenty were normal fetuses of matchable gestational age as controls. Transabdominal fetal echocardiography was obtained and the cardiac diameters and thickness were measured. The systolic function [stroke volume and cardiac output] and the diastolic function [E/A ratio] were obtained. There was a significant increase in cardiac diameters and thickness in FODMs and decrease in diameters in FOHMs. The pulmonary and aortic blood flow velocities were significantly faster in FODMs and slower in FOHMs. The diastolic functions were impaired in all patients. The stroke volume and cardiac output were significantly higher in FODMs and lower for the right ventricule in FOHMs than controls. Fetal echocardiographic examination showed significant changes in both cardiac anatomy and function in FODMs and FOHMs. The practical value of this non invasive technique is in need for further prospective comparative studies with the well established methods in obstetric decision making