High risk hypertensive pregnancies: maternal and foetal outcome

Hypertension in pregnancy: maternal and fetal outcomes according to laboratory and clinical features

OBJECTIVES

To determine the predictive value of clinical and laboratory parameters for maternal and fetal complications in pregnant women with hypertension.

DESIGN

Prospective data collection.

SETTING

Two primary referral hospitals in the southern suburbs of Sydney between March 1987 and July 1994.

SUBJECTS

1183 pregnant women with hypertension managed conjointly by a physician and obstetrician.

INTERVENTION

Uniform management protocol, plus antihypertensive medications if systolic blood pressure was persistently > or = 160 mmHg and/or diastolic blood pressure > or = 90 mmHg.

MAIN OUTCOME MEASURES

Maternal and fetal complications, as defined by the Australasian Society for the Study of Hypertension in Pregnancy Consensus Statement.

RESULTS

Of 825 women with pre-eclampsia (502 mild; 323 severe), univariate analysis showed that hyperuricaemia, proteinuria and severe hypertension were significantly associated with a higher rate of maternal and fetal complications. In multivariate analyses without confounders, only primiparity, low serum albumin levels and absence of diabetes were significantly associated with severe pre-eclampsia. Severe pre-eclampsia, high haemoglobin levels and low platelet count were associated with higher rates of small-for-gestational-age babies, but only low serum albumin levels were associated with increased perinatal mortality rates. Low birthweight was associated with severe hypertension and severe pre-eclampsia.

CONCLUSIONS

Simple clinical and laboratory parameters are useful predictors for maternal and fetal outcomes in pregnancies complicated by hypertension.