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Hypertension in pregnancy: maternal and fetal outcomes according to laboratory and clinical features
1Department of Medicine, St George Community Hospital, University of NSW.
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.