Hypertension in pregnancy: presentation, management and outcome - a retrospective analysis of 135 cases

In view of continuous controversies regarding hypertension in pregnancy and lack of reports on this subject in Saudi Arabia, we retrospectively studied 135 episodes of hypertension in pregnancy in 123 patients over a 9-years period. Fifty-one (37.8%) were primiparas, the remaining were multiparas from 2 nd up to 14 11 pregnancy. Of the multiparas, 44% had a history of pregnancy induced hypertension, 26% of chronic hypertension, and 13% of diabetes mellitus. " HELLP"-syndrome occurred in nine and eclampsia in four pregnancies. There were 10 foetal deaths, eight of them presented on admission. Chronic hypertension and diabetes mellitus approached significance as risk factors for foetal death (logistic regression analysis). For the whole group, the time of delivery was the only factor with significant impact on the Apgar score (multiple regression analysis), with an additional negative influence of diabetes mellitus and intravenous hydralazine in the multiparas. When the patients with chronic hypertension and diabetes mellitus were not included, hydralazine lost its significance. The finding suggests that intravenous hydralazine should be given in multiparas with caution, particularly in the presence of chronic hypertension and diabetes mellitus. There was a significant relation of the birth weight to the time of delivery, the serum levels of total protein and, especially in multiparas, of uric acid, confirming the importance of these factors as markers of the severity of pregnancy induced hypertension. The hypertension persisted in patients not known to have chronic hypertension in 9.6% of pregnancies during a follow-up ranging from 2 months up to 9 years.