https://doi.org/10.33698/NRF0238-Kumari Khushboo Saini, Jaswinder Kaur Kalra
Abstract: Introduction: Pregnancy is being most precious and very important time in every woman’s life. But sometimes pregnancy is associated with complications. About 7–15 % of all pregnancies are complicated by hypertension. Pregnancy induced hypertension is one of the leading causes of maternal and neonatal mortality and morbidity. Objective: To assess selected maternal, fetal and neonatal outcomes among antenatal mothers with pregnancy-induced hypertension. Material and Method: The study design was descriptive. It was conducted among antenatal mothers above 20 weeks of gestation diagnosed with PIH, attending Antenatal Clinic, PGIMER, Chandigarh. The sample size was 50 and purposive sampling technique was used. Results: More than half of mothers(56%) of age 26-30 years and 64.5% had gestational age of 37-40 weeks. About two third of mothers (64.5%) terminated pregnancy by cesarean section and 9.7% had 1st degree perineal tear. More than half of mothers(61.2%) had normal blood pressure after delivery. Nearly half of babies (48.3%) had APGAR score 8 at 1 minute and 58.06% had APGAR score 9 at 5 minutes. More than half of mothers(54.8%)initiated breastfeeding within 6 hours and 32.2% babies had birth weight more than 2.5 kgs. About, 67.7% newborns were admitted in NICU and 32.5% were healthy. Conclusion :Maternal and neonatal outcomes were good , may be because antenatal mothers were registered, supervised and delivered in tertiary care institution under supervision of expert obstetricians, neonatologists and nurses. Hence resulted into healthy mothers and neonates.
Keywords:–
Antenatal mother, pregnancy-induced hypertension.
Correspondence at
Dr. Avinash Kaur Rana Lecturer
National Institute of Nursing Education PGIMER, Chandigarh-160012
Introduction:
Hypertensive disorders of pregnancy are responsible for maternal and neonatal morbidity and mortality. Worldwide, it has been estimated that approximately 50,000 women die every year due to eclampsia.1 Hypertensive disorders of pregnancy affect 5-10% of all pregnancies, worldwide. The incidence of pre-eclampsia in nulliparous population ranges from 3 to 10 percent worldwide. The incidence of eclampsia varies between developed and developing countries is 1:100. Incidence of PIH is 15.2% in India, while it is four times higher in primipara women than multipara. Pregnancy induced hypertension leads to complications in both mothers and babies. It is associated with increased risk of adverse fetal, neonatal and maternal outcomes, including preterm birth, intrauterine growth restriction (IUGR), perinatal death, acute renal or hepatic failure, antepartum hemorrhage, postpartum hemorrhage and maternal death.1
Objective :
To assess selected maternal, fetal and neonatal outcomes among antenatal mo t h e r s w i t h p r eg n an cy – i n d u ced hypertension
Materials and Methods:
The study design was descriptive. It was conducted among antenatal mothers above 20 weeks of gestation diagnosed with pregnancy induced hypertension in Antenatal Clinic (ANC), at Postgraduate Institute of Medical Education and Research ( PGIMER), Chandigarh. Purposive sampling technique was used. The sample size was 50. Written informed consent was taken from the subjects. Interview schedule was prepared to assess maternal, fetal and neonatal outcome of women having pregnancy Induced Hypertension. Ethical clearance was taken f rom Institute Ethics Committee. Participants were interviewed in clean labour room of PGI, Chandigarh as per interview schedule.
Results :
Table 1 depicts that more than half of mothers( 56%) of age 26- 30 years, educational status of 38% was graduate and above, most of them (90%) were housewives and middle class(58%), more than half of them (62%) were Hindus by religion, About 90% of them lived in nuclear family and 66% had rural habitat. Most of mothers (96%) were vegetarians.
Clinical profile of mothers
Table 2 depicts that 34 % had previous history of hypertension in their previous pregnancy. Family history of hypertension was present in 44% mothers. Nearly 20% suffered from minor disorders of pregnancy like nausea and vomiting. Nearly two third of mothers had pain in extremities during their present pregnancy. Majority of mothers (94%) had normal micturition and majority of them (90%) had normal per vaginal discharge. Presence of edema at feet was reported by 68% mothers.
Table 3 depicts that 64.5% mothers had gestational age of 37-40 weeks. About two third of mothers(64.5%) terminated pregnancy by cesarean section and 9.7% had 1st degree perineal tear. Majority of mothers (61.2%) had normal blood pressure after delivery.
Table 4 shows that 64.5% had gestational age of more than 37 weeks, 64.6% were male babies whereas 48.3% had APGAR score of 8 at 1 minute and 58.06% had APGAR score 9 at 5 minutes. More than half of mothers ( 54 . 8 %) initiated breastfeeding within 6 hours and 32.2% had birth weight more than 2.5 kgs. Two third Newborns ( 67.7% ) were admitted in NICU and 32.5% were healthy.
Table 1: Socio demographic profile of mothers
N =50
| Variables | Group
n = 50 (%) |
| Age (years)
20-25 26-30 31-35 36-45 |
07 (14)
23 (56) 11 (22) 09 (18) |
| Educational status of mother
Primary Secondary Graduate and above |
14 (28)
17 (34) 19 (38) |
| Educational status of husband
Primary Secondary Graduate and above |
08 (16)
22 (44) 20 (40) |
| Occupation of mother
Professional Skilled worker Housewife |
03(6)
02 (4) 45 (90) |
| Occupation of husband
Professional Clerical/shop owner/farmer Skilled worker |
09 (18)
07 (14) 34 (68) |
| Per capita income (INR)#
Middle class(1733-2886) Lower middle class(866 -1732) Lower class(<866) |
29 (58)
17(34) 0 4(8) |
| Religion
Hindu Sikh/Muslim |
31 (62)
19 (38) |
| Family type
Nuclear Joint |
45 (90)
5 (10) |
| Habitat
Urban Rural |
17 (34)
33 (66) |
| Dietary habits
Vegetarian Non vegetarian |
48 (96)
2 (4) |
#according to BG Prasad scale, 2015
Discussion
Hypertensive disorders of pregnancy are one of major causes of deaths in pregnant mothers. These disorders complicate pregnancy, lead to major threats to mothers and their babies. Among them 7- 1 0 % o f p r e g n a n c i e s s u f f e r f r o m hypertensive disorders of pregnancy. It includes chronic hypertension, gestational hypertension, and a group of conditions associated with high blood pressure during pregnancy. Furthermore, these conditions remain one of the largest single causes of maternal and fetal morbidity and mortality.1 Pregnancy induced hypertension leads to complications in both mothers and babies. It is associated with increased risk of adverse fetal, neonatal and maternal
Table 2: Clinical profile of mothers
N=50
| Variables | F (%) |
| History of past medical illness
Hypertension TB Blood transfusion Thyroid disorder Malaria Renal disease Diabetes Rheumatic fever Heart disease No specic illness |
17 (34) 05 (10) 05 (10) 03 (6) 04 (8) 03 (6) 02 (4) 02 (4) 01 (2) 08 (16) |
| Family history Hypertension Diabetes Malaria
TB Multiple birth Mental illness |
22 (44) 11 (22) 05 (10) 04 (8) 04 (8) 03 (6) |
| Minor disorders in pregnancy (digestion)
Vomiting Nausea Constipation |
33 (66) 10 (20) 07 (14) |
| Pain Extremities Back
Abdomen |
31 (62) 11 (22) 08 (16) |
| Micturition
Normal Frequent |
47 (94) 03 (6) |
| Discharge p/v
Normal Excessive * |
45 (90) 05 (10) |
| Signs and symptoms of PIH
Edema(feet) Headache Ringing in ears No specic sign |
34(68) 04(8) 03(6) 09(18) |
*discharge of p/v (excessive)-white, watery and odorless
outcomes, including preterm birth, intrauterine growth restriction (IUGR), perinatal death, acute renal or hepatic failure, antepartum haemorrhage,postpartum haemorrhage and maternal death. According to present study, nearly one fourth of mothers had age range 31 to 35
Table 3: Maternal outcomes of mothers
N=31
| Variables | f (%) | |
| Gestational age at delivery(weeks) | ||
| 11(35.4) | ||
| 33-36 | ||
| 37-40 | 20 (64.5) | |
| Mode of delivery | ||
| 11 (35.4) | ||
| Vaginal Delivery | ||
| Cesarean Section | 20 (64.5) | |
| Perineal tear (1st degree) Yes | 03 (9.7) | |
| BP after delivery | ||
| Normal | 19 (61.2) | |
| Pre hypertension | 12(38.7) |
Table 4 : Fetal outcomes of subjects N=31
| Variables | f (%) |
| Gestational age of newborn (weeks)
<37 >37 |
11( 35.4)
20 (64.5) |
| Sex of Newborn
Male Female |
20 (64.5)
11 (35.4) |
| APGAR at 1 min
7 8 9 |
10 (32.2)
15(48.3) 6 (19.3) |
| APGAR at 5 min
7 8 9 |
02 (6.4)
11 (35.4) 18 (58.06) |
| Initiation of breast feeding:(within)
Half an hour 6 hours 24 hours |
06 (19.3)
17 (54.8) 08 (25.8) |
| Baby weight (kg )
1.5-2.0 2.1-2.5 >2.5 |
05 (16.1)
16(51.6) 10(32.2) |
| Admission in NICU
YES NO |
21 (67.7)
10 (32.2) |
| Neonatal outcome
Healthy IUGR L BW Death |
10 (32.5)
04 (22.5) 15 (38.7) 02 (6.4) |
years. A study by Lamminpaa et al stated that maternal age as an important factor. Pregnancy induced hypertension is common in rst pregnancy (primipara 40% as compared with 10 % in multipara) and women over the age of 30 years because of associated multiparty.2 E d e m a i s c o m m o n i n n o r m a l pregnancy, but generalized edema is a danger sign of preeclampsia. The present study results showed that only few mothers had +1 pedal edema. A study by Begum reported that cesarean sections (cases with PIH) were 3.8 times more, and also revealed PIH was associated with increased cesarean section. The greater the severity of HTN, the more are the complications associated with it during pregnancy.3 Zibaeenezhad et al. reported a 45.8% rate.4 In present study, more than half of pregnancies (64.5%) had been terminated by cesarean section.
Birth weight of newborn born to hypertensive mothers is lower than normal. The birth weight of babies born to chronically hypertensive mothers is also l o w e r t h a n p r e g n a n c y – i n d u c e d hypertensive mothers. In present study, nearly about half of babies (16 out of 31) born to hypertensive mothers had birth weights less than 2500 gms. Out of the them, one third of newborns (10 out of 31) weighed less than 2000 gms. A study by Brown and Buddle reported fetal outcomes, out of 56 babies, 59% had appropriate weight in relation to their age and 66% had good APGAR score which substantiates the results of Chaim et al. who had 99.2% newborns with good APGAR score after 5
Conclusion:
Maternal and neonatal outcomes were good , may be because antenatal mothers were registered, supervised and delivered in tertiary care institution under supervision of expert obstetricians, neonatologists and nurses. Hence resulted into healthy mothers and neonates.
References
- Dutta DC. Textbook of Obstetrics.7th edition. Calcutta. New Central Book publications:
- Lamminpaa R, Julkunen K, Gissler M, H e i n o n e n S . P r e e c l a m p s i a complicated by advanced maternal age: A registry based study on primiparous women in Finland. 1997- BMC Pregnancy Childbirth 2012; 12(1):47. doi: 10.1186/1471- 2393-12-47.
- Begum A, Ganguly Rate of C a e s a r e a n o p e r a t i o n a n d complications in hypertensive disorders of pregnancy. The ORION Medical Journal 2007;(27): 463-66.
- Zibaeenezhad, MJ, Ghodsi M, Arab P, Gholzom The Prevalence of Hypertensive Disorders of Pregnancy in Shiraz, Southern Iran. Iranian Cardiovascular Research Journal 2010;(4): 169-72
- Brown MA, Buddle Hypertension in pregnancy: Maternal and fetal outcomes according to laboratory and minutes of life.5,6 In present study. all clinical features. The Medical Journal newborns had good APGAR scores (>7) at 1 and 5 minutes. of Australia 1996 ;165(7): 360-65
- Chaim SP, Olivia SV, Kimura Pregnancy-induced hypertension and the neonatal outcome. Acta Paulista de Enfermagem(2008) [cited on 2017 O c t ] A v a i l a b l e f r o m : URL<http://dx.doi.org/10.1590/S010 3-21002008000100008>