Pregnancy-induced hypertension (PIH) is defined as systolic blood pressure (SBP) >140 mmHg and diastolic blood pressure (DBP) >90 mmHg after 20 weeks of gestation without proteinuria. It is classified as mild (SBP 140-149 and DBP 90-99 mmHg), moderate (SBP 150-159 and DBP 100-109 mmHg) and severe (SBP≥160 and DBP≥110 mmHg) [1]. Pregnancy-related hypertensive disorders have been divided into four groups by organizations like the United Nations Organization and the American College of Obstetricians and Gynecologists (ACOG): preeclampsia/eclampsia, chronic hypertension (HTN), pregnancy-induced hypertension (PIH), and superimposed preeclampsia/eclampsia. Globally, PIH is a major public health concern that contributes to a high rate of perinatal fatalities in both industrialized and developing nations [2-3]. The maternal mortality ratio in India is 99/100 000 live births (90-108) in 2020 due to complications related with pregnancy and childbirth [4]. Numerous risk factors for hypertensive diseases during pregnancy have been reported in international literature, including smoking, alcohol use, heart failure, stroke, obesity, family history of hypertension, and left ventricular hypertrophy [5]. 10% of pregnancies can result in complications from hypertensive disorders, which can cause serious problems like eclampsia, placental abruption, preterm delivery, pulmonary edema, thrombocytopenia, hemolytic anemia, stroke, recurrent seizures, renal damage, hepatic injury, the hemolysis syndrome, elevated liver enzymes, low platelets, and HELLP syndrome. These complications can ultimately cause maternal and neonatal mortality [6]. HELLP syndrome is one of the common causes of maternal and fetal mortality among pregnant women with hypertension. Hypertensive disorders of pregnancy (HDP) predispose women to acute or chronic utero-placental insufficiency, resulting in ante or intra-partum asphyxia that may lead to fetal death, intrauterine growth retardation and/or preterm delivery [7]. The complications can be prevented by more widespread use of prenatal care, education of primary medical care personal, prompt diagnosis of high risk patients and timely referral to tertiary medical centers and institutional management [8]. With the help of efficient antenatal care and early treatment of pregnancy induced hypertensive disorders has become almost a clinical rarity in developed countries. However, in developing country like India and in the rural population, it still continues to be a major obstetric problem.

Aims & objectives: Present study evaluates the foetal and maternal outcome among pregnancy induced hypertension women in third trimester of pregnancy

The Department of Obstetrics and Gynecology at an Indian Medical College conducted this cross-sectional observational hospital-based study. Pregnant women with signs and symptoms of pregnancy-induced hypertension who were hospitalized to our hospital in the third trimester

Inclusion criteria

• Women diagnosed as pregnancy induced hypertension in third trimester of pregnancy
• Patient with BP more than 140/90 mmHg
• Patients who give consent for participation in the study

Exclusion criteria

• Women suffering from essential hypertension
• Patients with known case of epilepsy
• Patient in first and second trimester of pregnancy
• Patient who did not give consent

A total of 80 cases of PIH in third trimester of pregnancy were enrolled and analysed in this study

After taking informed written consent detail history of patient history, basic demographic variables, high risk factors, relevant investigation and treatment given was recorded in proforma.

Routine general physical examination was done, If blood pressure was >140/90, the subject was made to rest for 30 min and checked again to confirm the diagnosis of PIH. Systemic examination and routine obstetric examination were done thoroughly, followed up till delivery to evaluate fetal outcome and maternal outcome

Statistical Analysis: The statistical software SPSS was used for the analysis and Microsoft Excel has been used to generate graphs, tables, etc. Fisher exact test has been used to find the significance of study parameters on continuous scale between two groups. It was considered significant if P< 0.05.

A total of 80 patients of PIH in third trimester of pregnancy were included and analysed in the study.

Most common age group was 21-25 years (48.7%) cases. More than half of the patients were from rural area and most of them belonged from lower-middle socio economic section. Proportion of primi was slightly higher (53.7%) and majority of the women (73.7%) were full term (>37 weeks of gestation) [table: 1]

Table 1: Distribution of socio-demographic variables among the study subject

Pattern of clinical representation among PIH patients were pain in lower abdomen (70%), pedal edema (40%), headache (15%), dizziness (12%), burning of vision (9%), epigastria discomfort (8%),  convulsion (7%) and 20% had asymptomatic [graph:1]..

Overall incidences of LSCS were 31.3% and normal vaginal delivery was 68.7%. The common maternal outcomes were Placental abruption (11.3%), postpartum hemorrhage (10%), Posterior reversible encephalopathy syndrome (8.7%), pulmonary oedema (7.5%), maternal mortality (3.7%), HELLP syndrome (2.5%), ARF (1.3%), DIC (1.3%) and ARDS (1.3%) [Table: 2].

Table 2: Maternal outcomes among PIH cases

Table 3 shows the fetal outcomes of PIH mothers. Preterm delivery were most common (40%) followed by LBW (38.7%), NICU admission (32.5%), neonatal sepsis (10%), meconium aspiration syndrome (7.5%), IUGR (7.5%), post term (6.3%)  Transient tachypnoea of new-born (5%), still birth/IUFD (1.3%) and 6.3% neonatal death were reported

Table 3: Fetal outcome in mothers with PIH

The majority of cases in this investigation were in the age range of 21 to 25, which is consistent with a similar pattern observed by Agida ET et al. [9] and Bhageerathy et al. [10]. Advanced maternal age has been identified as an independent risk factor for pregnancy induced hypertension (PIH). This is most likely due to the fact that we are working with women from rural areas of northern India, where early marriage is more prevalent.

In the present study, most of the PIH women from rural areas and also belonged to lower socio-economic status, accordance to Kahsay HB, et al [11] and Agrawal S, et al [12]. Lower socioeconomic status and rural residences also associated with the low educational level found as risk factors for hypertensive disorders of pregnancy The majority of PIH patients in our study were primigravida and older than 37 weeks; these findings were in line with those of Sengodan et al. [13] and Babore et al. [14]. It is known that due to maternal and/or fetal reasons, pregnancies with hypertension disorders may be a risk for iatrogenic delivery.

The common clinical representation of PIH showed that mothers had pain in lower abdomen, pedal edema, headache and dizziness in the current study; our results were comparable with the Pandya K, et al [15].  In line with Yadav V et al. [16] and Dev K et al. [17], the majority of patients with pregnancy-induced hypertension in our study were delivered vaginally. However, in contrast to our study, Dyal M et al. [18], 40% of deliveries of pregnancy-induced hypertension were carried out via caesarian section, and 20% were delivered instrumentally. The goal of care is to stabilize the patient and deliver them as quickly as possible. This may entail caesarean sections, induction of labor, or cervical ripening (for patients with an unfavorable cervix). Fetal distress and deteriorating mother health were the most frequent reasons for cesarean sections.

In present study there was significant difference noted in foetal and maternal outcome if admission/induction delivery interval was less than 12 hours, and when the interval was more than 12 hours, concordance with the Kelkar D et al [19]. According to the current study, the most frequent maternal complications among pregnant women with PIH were placental abruption and PPH; these results are consistent with those of Un Nisa et al. [20].  The prevalent maternal outcome in PIH patients, according to our research, was placental abruption followed by PPH, PRES, pulmonary oedema, and maternal fatalities from HELLP syndrome and ARF. Our findings are in line with those of Akhila NR et al [21].

In our study the birth weight of babies in the PIH women was significantly lower, accordance with the Rajanna SP et al [22] and Obi CN, et al [23]. The common cause of low birth weight is intra uterine growth restriction (IUGR) that may be precipitated by the PIH and iatrogenic prematurity. Me conium Stained Liquor was significantly higher in PIH cases as compared to the normotensive women, our finding was comparable with Patel S, et al [24].

According to Aabidha et al. [25], the majority of babies born to patients with pregnancy-induced hypertension were preterm, with the majority of deliveries in PIH being preterm as well.  Preterm newborns, low birth weight, NICU hospitalization, IUGR, meconium aspiration syndrome, and fetal mortality were the most common foetal outcomes in the current study. Numerous other studies, including Acharya et al. [26] and Alam A. et al., also revealed comparable results.[27]  As one of the most prevalent pregnancy problems, bad maternal and neonatal outcomes in PIH are crucial for physicians to understand; the purpose of this study is to raise awareness in order to prevent maternal and newborn death and morbidity. Preeclampsia and eclampsia are the major causes of high morbidity and mortality for both mother and baby, particularly in developing countries.

One of the main causes of morbidity and mortality for both mothers and fetuses is pregnancy-induced hypertension, a common problem among expectant mothers. Preterm delivery, LBW, NICU hospitalization, and IUGR newborns are among the fetal difficulties caused by PIH, whereas maternal complications include PPH, placental abruption, pulmonary oedema, and ARF. In order to reduce feto-maternal fatalities and morbidities from PIH, it would be beneficial to educate the reproductive age group's eligible women who are at risk of developing hypertensive disorders of pregnancy to attend regular prenatal checkups, screening, and early intervention.

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