A hospital - based epidemiologic study of hypertensive disease in pregnancy

الملخص EN

Objective : analyze the epidemiologic characteristics of hypertensive disease in pregnancy among women attending for care and delivery in the Salmaniya Medical Complex and peripheral Maternity Units in Bahrain between 1st Jan.

2001 to 31st.

Dec.

2003.

Design : retrospective analytical study of all maternity admissions and deliveries during this period.

Archival records, labor ward registers, the Medical Records 'data base' and case records of patients were reviewed [with regard to nationality, age, parity, antenatal care, onset and severity of hypertension, albuminuria, gestational age at delivery, mode of delivery, complications of intra partum and post-partum complications].

Results : among 31639 patients delivered during this period there were 934 patients with hypertension, (incidence rate 2.8 %).

The Bahrainis comprised 85.8 % while the non-Bahrainis were mainly from the Indian subcontinent (8.6 %), from the Philippines (2.9 %) and (2.5 %) for different nationalities.

The median age was 29.81(SD+ = -7.207) with 26 % in 15-25 year age group, 49 % in 26-35 group and 24 % in 36-45 year group.

Primiparity seems to be a significant risk factor for hypertension and 30 % of patients belonged to this group.

This risk decreased gradually with every further gestation until the fourth.

Afterwards the risk is more parallel to age than to parity.

There is an obvious seasonal variation in the incidence of pregnancy induced with higher number of admissions in the summer months (Aug.- Nov) and lower incidence during the mild winter-spring season (Dec-May).

According to the prevalence of PIH in relation to the period of gestation 62 % of cases occurred during the antenatal period, 22 % where intra partum and 16 % in post-partum.

Severe preeclampsia was observed in 28.3 % of cases, while mild to moderate in 62.5 %.

Cases of hypertension without albuminuria werelO.2 %.

There were 11 cases of eclampsia (1.2 %) and two cases of HELLP syndrome (0.2 %).

Small for gestational age occurred in 30.3 %, out of which 67.6 % were delivered preterm and 23 % were at term.

The Caesarean section rate was 32.7 %, with 65.7 % emergency and 34.3% were elective.

There was only one maternal death in this series in a case of abruption followed by severe post-partum hemorrhage, 9 cases of stillbirth (1 %) and 8 neonatal deaths (0.9 %).

Conclusion : although incidence of preeclampsia is relatively low and the management is effective in preventing and treating cases of pre-eclampsia and eclampsia in this study the morbidity was considerable with longer hospitalization, higher incidence of caesarean deliveries, critical care (ICU), perinatal mortalities and maternal death.

The extent of morbidity is much worse when the patients had little or no prenatal care.

This calls for new strategies for the prevention and early diagnosis of pregnancy induced hypertension.