The Prevalence and Types of Hypertensive Diseases in Pregnant Women Admitted to Department of Obstetrics and Gynecology in Tanta University Hospitals

Abstract
Background: Hypertensive disorders of pregnancy are used as an umbrella term that includes chronic and gestational hypertension, preeclampsia and eclampsia, representing a major cause of maternal and perinatal morbidity and mortality, considered to be the most common medical problem encoun-tered during pregnancy, and so this study was done to find the prevalence and types and the proper methods of treatment of each type of hypertension in pregnant women admitted to Department of Obstetrics, Tanta University Hospital.
Aim of Study: The aim of this study is to find the prevalence and types of hypertension in pregnant women admitted to Department of Obstetrics, Tanta University Hospital.
Patients and Methods: This prospective, randomized, comparative study included Seven hundred and fifty (750) pregnant women in the Department of Obstetrics and Gyne-cology in Tanta University Hospital during the period between December 2016 and December 2017. In this study, hypertensive pregnant females were categorized in to 4 major groups: Chronic hypertension, gestational hypertension, pre-eclampsia, eclampsia and no cases of superimposed pre-eclampsia on top of chronic hypertension were encountered. Informed consents were obtained from all study participants.
Results: Number of patients examined in this study was 750 pregnant women, 179 were hypertensive (23.86%). Chron-ic hypertension 15 cases (8.37%), gestational hypertension 61 cases (34.07%), pre-eclampsia 90 cases (50.27%) and eclampsia 13 cases (7.26%), according to the clinical charac-teristics, the mean age was significally higher in chronic hypertensive group (40.53±5.3 years), and was significally lower in eclamptic patients (23.31±4.33 years), the highest gravidity was recorded in chronic hypertension (3.20±0). The body mass index was similar in all the studied groups. Blood pressure was highest in preeclampsia, according to methods of delivery in different studied groups, assisted and spontaneous vaginal delivery were highest in gestational hypertension (23%) and (13.1%) respectively and Caesarian section was highest in eclampsia (84.6%) and lowest in chronic hyperten-sion (60%), the gestational age of the studied groups was showing that prematurity was encountered in 61.54% of cases of eclampsia and was lowest (0%) in chronic hypertension; this was due to induction of labor, the main cause of death in this study is prematurity. The mean APGAR score in the present study was highest in chronic hypertension group (7.40 ±1.88) and lowest in eclamptic group (5.08±1.19) after one minute of delivery and after 5 minutes APGAR score was highest in pre-eclamptic (8.80±1.52) and lowest in eclamptic group (7.23±1.88). The respiratory distress syndrome, Neonatal Intensive Care Unit and neonatal mortality were highest in eclampsia group (3 8.5%, 30.8% and 23.1% respectively) and lowest in chronic hypertension group (0% in all), a comparison between 2 forms of pre-eclampsia (mild and severe) showed that all the parameters including blood pressure, hematocrit value, creatinine, uric acid levels and liver enzymes were higher in severe preeclampsia compared to the mild form. C.S was 100% in severe pre-eclampcia and 73.01% in mild pre-eclampcia, the respiratory distress syndrome, Neonatal Intensive Care Unit and neonatal mortality were significally higher in severe pre-eclampcia than mild pre-eclampcia, gestational age and birth weight were significally higher in severe pre-eclampcia than mild pre-eclampcia, Intra Uterine Growth Restrictions (I.U.G.R) were found only among the severe pre-eclampcia group (18.52%).
Conclusions: From this study we can reach the following conclusions:
1-High blood pressure complicates 23.9% of all pregnant women.
2-The incidence of chronic hypertension in the present study is 8.37%, gestational hypertension is 34.1%, pre-eclampsia is 50.3% and eclampsia is 7.3%.
3-The worst prognosis was found among the eclamptic group.
4-Chronic hypertension when perfectly managed doesn't develop into superimposed pre-eclampsia.
5-No cases of secondary chronic hypertension were encoun-tered in the study denoting that it is rare with pregnancy. The cause of secondary hypertension may compromise her fertility.
6-Neonatal complications were most common with pre-eclampsia and eclampsia.