Fetal outcome in hypertensive disorders of pregnancy

Fetal outcome was evaluated in 157 hypertensive pregnant women whose underlying disease had been established by renal biopsy. The patients had pathologic diagnoses of preeclampsia (95), nephrosclerosis (23), nephrosclerosis with superimposed preeclampsia (13), interstitial and tubular nephropathy (seven), and normal findings (six). Pregnancy outcome in this selected group of patients was extremely poor, with the perinatal mortality rate being 134 per 1,000. There were 21 perinatal deaths; three quarters of these were stillbirths, and most were encountered below the fiftieth weight percentile and before 30 weeks' gestation. In addition 22% of the infants were small for gestational ages, and 40% of the infants were born before term. Most of the perinatal mortality (81%) was in women with preeclampsia. The worst fetal outcome was encountered in multiparous preeclamptic women, over 50% of whom manifested nephrotic-range proteinuria during pregnancy. Despite the presence of hypertension throughout most of their gestation, women with nephrosclerosis alone had the best fetal survival rate.