Department of Obstetrics & Gynecology, Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia; Department of Obstetrics & Gynecology, Universitas Airlangga Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Department of Obstetrics & Gynecology, Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Pregnancy Hypertens. 2019 Apr;16:154-160. doi: 10.1016/j.preghy.2019.04.007. Epub 2019 Apr 22.
Chronic hypertension in pregnancy is an important cause of maternal and neonatal morbidity and mortality. The aim of this study was to determine the effect of severity of chronic hypertension in pregnancy on maternal and perinatal outcome in an Indonesian population.
This study was performed in Dr Soetomo General Hospital, a tertiary center in East - Java, Indonesia over the period of 2013-2017. Chronic hypertension (CH) was divided using JNC VII criteria, as stage 1 (Blood pressure ≥140/90 mmHg) and Stage 2 (BP > 160/110 mmHg) hypertension.
The primary outcomes were maternal and perinatal outcome. Data was statistically analyzed using Chi-square, Fischer exact test, and Mann-Whitney test (program: SPSS ®23).
Over these 5 years, 352 patients were diagnosed with CH. The stage 2 of CH was associated with worse maternal outcome: maternal death (5.6% vs 0.8%; p = 0.016), laboratory values of urinary protein +3 (67% vs 21,5%, p = 0.001) and +4 (12.3% vs 0.4%, p = 0.001), LDH > 600 IU/L (11.3% vs 5.3%, p = 0.04), ALT > 70 IU/L (11.3% vs 4.1%, p = 0.01), AST > 70 IU/L (12.3% vs 5.3%, p = 0.02), BUN > 25 mg/dL (27.4% vs 8.1%, p = 0.001), SK > 1.1 mg/dL (29.2% vs 6.5%, p = 0.001) and Albumin <3 g/dL (65.1% vs 10.2%, p = 0.001), need for ICU admission (76.4% vs 36.6%, p = 0.001), mechanical ventilation (48.1% vs 21.1%, p = 0.001), and occurrence of complications (72.6% vs 57.7%, p = 0.006). Stage 2 CH in pregnancy was associated with an increased risk of maternal death (OR: 7.22; 95% CI: 1.43-36.36; p = 0,016). Stage 2 CH was also associated with worse perinatal outcome, in terms of lower birth weight (1635 ± 863.27 vs 2063.74 ± 935.43, p = 0.001), lower Apgar score (p = 0.001), and number of intra uterine complications such as: IUGR, stillbirth, and placental abruption (27.4% vs 11.8%, p = 0.001).
Stage 2 CH in pregnancy is associated with worse maternal and perinatal outcomes compared with stage 1. Intervention to prevent disease progression to stage 2 before pregnancy may improve maternal and perinatal outcomes during pregnancy.
妊娠慢性高血压是孕产妇和新生儿发病率和死亡率的重要原因。本研究旨在确定印度尼西亚人群中妊娠慢性高血压严重程度对母婴结局的影响。
本研究在印度尼西亚东爪哇省的苏托莫综合医院进行，时间为 2013 年至 2017 年。使用 JNC VII 标准将慢性高血压（CH）分为 1 期（血压≥140/90mmHg）和 2 期（BP>160/110mmHg）高血压。
主要结局是母婴结局。使用卡方检验、Fisher 确切检验和曼-惠特尼检验（程序：SPSS®23）对数据进行统计学分析。
在这 5 年中，共有 352 例患者被诊断为 CH。2 期 CH 与较差的母婴结局相关：产妇死亡（5.6% vs 0.8%；p=0.016）、尿蛋白+3（67% vs 21.5%，p=0.001）和+4（12.3% vs 0.4%，p=0.001）、LDH>600IU/L（11.3% vs 5.3%，p=0.04）、ALT>70IU/L（11.3% vs 4.1%，p=0.01）、AST>70IU/L（12.3% vs 5.3%，p=0.02）、BUN>25mg/dL（27.4% vs 8.1%，p=0.001）、SK>1.1mg/dL（29.2% vs 6.5%，p=0.001）和白蛋白<3g/dL（65.1% vs 10.2%，p=0.001）、需要入住 ICU（76.4% vs 36.6%，p=0.001）、机械通气（48.1% vs 21.1%，p=0.001）和发生并发症（72.6% vs 57.7%，p=0.006）。妊娠 2 期 CH 与产妇死亡风险增加相关（OR：7.22；95%CI：1.43-36.36；p=0.016）。2 期 CH 还与更差的围产期结局相关，表现在出生体重较低（1635±863.27 vs 2063.74±935.43，p=0.001）、Apgar 评分较低（p=0.001）以及宫内并发症数量增加，如 IUGR、死胎和胎盘早剥（27.4% vs 11.8%，p=0.001）。
与 1 期相比，妊娠 2 期 CH 与较差的母婴结局相关。在妊娠前进行干预以防止疾病进展为 2 期可能会改善母婴妊娠结局。
