A study of risk factors and outcome in pregnancy induced hypertension

Abstract

Background and Objectives: Pregnancy Induced Hypertension (PIH) has an adverse outcome for mother and fetus and despite antihypertensive therapy patients do develop complications. This study assesses Dermatoglyphic, clinical and investigative profile of the patients and their possible bearing on PIH and success of therapy. Such evidence may be useful to therapeutic decisions for better outcomes. Patients and Method: The study was conducted in pregnant patients attending the ante-natal clinic and later admitted for confinement under Obstetrics and Gynecology department of Sir Sunderlal Hospital of BHU, Varanasi between the period of October 2015 and September 2016. PIH cases had blood pressure >140/90 mm of Hg plus dipstick positive proteinuria. Patients with known co-morbidity except gestational diabetes were excluded. Demographic, clinical and investigative profiles of cases were recorded and outcomes noted. Their relation to PIH severity was studied. Patients were dichotomized on the basis of the median value of systolic blood pressure. Result: The study was conducted in 87 cases of PIH. More severe PIH were seen in primigravidas, overweight patients, patients married at a younger age with early pregnancy after marriage. It was also associated with certain Dermatoglyphic patterns indicating the role of a genetic factor. Anogenital distances indicated the role of androgenization in the severity of PIH. The starting drugs were Methyldopa and Labetalol as monotherapy but despite treatment severe PIH was associated with the impaired renal function, elevated liver enzymes, more frequent eclampsia, high incidence of IUGR and babies born with low Apgar score. Conclusion: The study reveals well-grown mothers with some gap after marriage in acquiring pregnancy to be favorable factors for avoiding severe PIH. Masculinization is a risk factor for which therapy needs to be contemplated although not in current practice. Narrow atd angle in right hand may appear as an easy Dermatoglyphic parameter to predict risk and exercise greater vigilance against the development of PIH. The antihypertensive therapy currently used is pretty effective in reducing fetal compromise but cases initially reporting with severe PIH do not appear to be protected from worsening to eclampsia. This warrants contemplation of additional/better therapeutic approach and measures.