PREVALENCE OF HYPERTENSION IN PREGNANCY IN RURAL SOUTH INDIA

Dr. B. Jayaraju 1 , Dr. Elias Ahmed 2 , Dr. Prabhakar Rao 3 and Dr. Srininvas 4 . 1. Asso. Prof. Bhaskar Medical College R.R Dist., Telangana. 2. Assistant Prof. FIMS, Kadapa, A.P. 3. Prof. Shanthiram Medical college Nandyal, A.P. 4. Prof. FIMS, Kadapa, A.P. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

Hypertension in pregnancy is a most common medical complication. It range from a mild-to-severe and major cause of material & perinatal morbidity and mortality. Hypertension during pregnancy (Pregnancy-Induced Hypertension (PIH), Preeclampsia, Eclampisa) is difficult to treat. Eclampsia and preeclampsia contribute to death of one women every 3 minutes world wide. Hypertension disorder in pregnancy are the third leading cause of maternal mortality after other causes like hemorrhage & sepsis. Pregnancy specific syndrome. It occurs in 5% of all pregnancies, 10% of first pregnancies and 20-25% of woman with chronic hypertension. There are only isolated documentations of hypertension in pregnancy in India Hypertension is present in 6-8% of young women of childbearing age but the prevalence increases with advancing age and in women with diabetes mellitus, primary renal disease or collagen vascular disease reading up to 20 % in such population.
The question of whether hypertension in pregnancy and specifically pre-eclampsia are a marker for cardiovascular disease later in file has implications for health promotion in women , similar to the link between gestational diabetes and the later development of clinical diabetic state. To evaluate such a risk, long follow-up will be necessary. Maternal diastolic blood pressure of more than 110 mmHg is associated with an increased risk for abruptioplancentae, intrauterine foetal death. Severe maternal complications include eclamptic oedema, acute renal failure, and proteinuria greater than 4.5 g/dl, liver dysfunction, disseminated intravascular coagulation and consumptive coagulopathy. Perinatal mortality and morbidity are also high due to chronic placental insufficiency and growth restriction of foetus.
Aims And Objectives:-1. To find out prevalence of hypertension in pregnant women attending antenatal outpatient department of the hospitals. 2. To estimate the prevalence of hypertension in pregnancy.

Materials and Methods:-
The present prospective study was carried out jointly in the department of between January 2015 to July 2015 416 pregnant women attending the antenatal outpatient department were screened foe hypertension. Blood pressure were measured in the supine, left lateral and sitting position in the both the upper limbs. Systolic blood pressure of more then 140 mmHg and diastolic blood pressure of more than 90 mmHg are taken as cut of values for labeling a pregnant woman as hypertensive. Disappearance of Korotkoff's sound phase V was taken as cut-off for diastolic blood pressure measurement. Age parity, gestational age at which blood pressure are recorded, pervious obstesrtric history of pregnancy-included hypertension and its complications, family history of hypertension & diabetes mellitus, presence of petal edema or anasarca, excess weight gain are noted. Relevant laboratory investigations like complete urine examination, random blood sugar, liver function test, renal function test were done and value are noted. Results obtained were tabular and analyzed

Discussion:-
Hypertension in pregnancy has long been suspected of heralding an increased risk of high blood pressure in later life. In the population studied, blood pressure of 140/90 mmHg & above was seen in 34 pregnant women. This accounts to an incidence of 8.2%. Hypertensive disorders complicating pregnancies have been reported in 6-8% and may go up to 20%. Proteinuria is seen in only 23.53% and majority of hypertensive women had no proteinuria. This shows that gestational hypertension or pregnancy-induced hypertension is the type of hypertension commonly seen in pregnancy. Pregnancy-induced hypertension and chronic hypertension was responsible for hypertension in 96% and 4% of cases respectively in an Indian study, chronic hypertension is not common. Oedema is seen in up to 80% of normal pregnant women & seen invariably in preeclampsia & eclampsia, pathologic oedema is the first sign of PIH. Excess weight gain (gaining more than ½ kg per week of gestation) is the first symptom of pregnancy-induced hypertension. Preeclampsia is seen in 10-15% of primigravidae with hypertension and 5.7-7.3% in multigravidae. Preeclampsia is hence peculiar to pregnancy. Elevated serum uric acid levels more than 4 mg/dL indicate foetal compromise and indicate need to deliver the foetus as early as possible. Serum uric acid level of more than 5.5 mg/dL is consistent with preeclampsia and above 6 indicates serious disease when liver dysfunction and mild elevation of serum transaminases occurs.
LFT, RFT Blood coagulation profile, ECG were normal in the study population. Ophthalmoscopy showed normal fundus. Retinal vasospasm is a manifestation of severe maternal disease. The study populations with high blood pressures were picked up early and hence they did not have complications. Incidence of preeclampsia is increased with twins & previous history of eclampsia. Pregnancy-induced hypertension is usually thought to resolve without serious sequelae, but a link to cardiovascular disease in later life was suggested from an early follow-up study of preeclamptic and eclamptic women and from an increased incidence of previous preeclampsia observed in women who had suffered myocardial infarction. Gerdur A et al study showed death rates from ischaemic heart disease are higher in women who had hypertension in pregnancy when compared with the general population, and that this risk might be linked to increasing severity of the disease in pregnancy. Four subsequent studies have since independently indicated a significantly increased risk of myocardial ischaemia and related cardiovascular disease later in life in 562 women who had hypertensive disorder in pregnancy. Pregnancy-induced hypertension may not only be an expression of underlying genotypic and phenotypic hypertensive tendency but has its own adverse and long term effect on the endothelium and the cardiovascular system. Women with preeclampsia or eclampsia should, therefore, receive follow-up and health care advice with regard to lifestyle, nutrition and weight control.

Conclusion:-
Pregnancy-induced hypertension is predominant in Indian pregnant women. In our study, this is confirmed. But study population is small, it requires large population studies to confirm the same. Chronic hypertension is less commonly seen. Blood pressure should be measured in sitting position with cuff at level of heart. Majority of deaths are preventable if pregnancy-induced hypertension is detected and treated early.