Variables associated with perinatal mortality in hypertensive adult pregnant women.

High blood pressure can occur in 5-10% of pregnancies and is a leading factor in perinatal mortality. The perinatal mortality rate is estimated to be three to five times higher in women with hypertension compared to those without it.

The present study described a hypertensive mother either with a stillbirth or if the baby died within seven days of life as case, while the next two consecutive hypertensive mothers who delivered a live baby that survived up to 7 days of life as controls. The study excluded fetuses with congenital malformations incompatible with life and multiple pregnancies. It finally included 112 women in cases and 224 women in controls.

The study observed-

• Among 112 cases of perinatal death, 70% died in utero prior to labor.
• Among 33 alive fetuses, 50% were born still after labor, and 50% died within seven days of birth. 
• Early onset hypertension (< 34 weeks), gestational age at termination of 28–32 weeks, the value of serum creatinine > 1.1 mg/dl, abruption, and birth weight < 1.5 kg showed a significant correlation with perinatal mortality. 
• Abnormal Doppler findings predicted perinatal deaths.

Early onset severe preeclampsia is associated with growth-retarded fetuses that require vigilant antenatal monitoring as they are likely to die in utero. The prediction of perinatal mortality can be made through abnormal umbilical artery Dopplers. Caesarean section at the gestational age of ≥ 32 weeks and an estimated fetal weight of ≥ 1.2 kg may cause a favorable outcome.

John B, Dorairajan G, Chinnakali P. et al. Factors Associated with Perinatal Mortality in Adult Pregnant Women with Hypertensive Disorders: A Case–Control Study. J Obstet Gynecol India. 2023. https://doi.org/10.1007/s13224-023-01782-8