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7/26/2019 Patient's profile with Hypertension in Pregnancy Patients
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Patients Profile with Hypertension in Pregnancy
at Sanglah Hospital in 2009-2010Profil Penderita Hipertensi Dalam Kehamilan
di RSUP Sanglah Denpasar Tahun 2009-2010
Hendrik Sutopo, I Gede Putu Surya
Department of Ostetri!s and "#ne!olog#$
%edi!al &a!ult# of Uda#ana Uni'ersit#(
Sanglah Hospital Denpasar - )ali
Abstract
Objective To report the profile of patients with Hypertension in Pregnancy (HIP)
at Sanglah Hospital Denpasar from !!" until !#!$
!etho"s % retrospecti&e descripti&e study from all HIP patients at SanglahHospital Denpasar, 'ali during anuary !!" until Decemer !#!$
#es$ltsThe pre&alence of HIP at Sanglah Hospital was ",*+, which consists of
#$+ gestational hypertension, !$#"+ chronic hypertension, #$*-+ mild preeclampsia,
.$/!+ se&ere preeclampsia, !,.*+ superimposed preeclampsia, and !$+ eclampsia$
0rom all of HIP cases, we found that the ma1ority were nulliparous (./,*+),
primipaternality (2*$#+), and known hypertension at term (2#$"+)$ 3ost of the cases
was found at maternal age 4 *2 years (#.,-+), followed y age 5 ! years (#*$./+)$
3ost of the cases had %nte 6atal 7are (%67) fre8uency 9 . times (-",!"+), and the
most of them had %67 at midwife (2,/-+) then followed at :;Gyn (.!,#+)$ The
ma1ority of the cases were referral case (-,*"+) with the ma1ority cases were referred
y midwi&e (,.2+)$ 0rom all of the cases, we found that total preterm laour was
*2,#.+, perinatal mortality was ",*+ and maternal mortality was #$#-+$
%oncl$sionThe pre&alence of HIP at Sanglah Hospital was higher than pre&ious
years$ The most of HIP cases already had %67 y health care pro&iders, and the
ma1ority health care pro&iders were midwi&e and :;Gyn$ Therey, the 8uality of %67
seems necessary to e impro&ed y earlier refferal system, so the cases can e treated
earlier$
&eywor"shypertension in pregnancy, preeclampsia and eclampsia, descripti&e
Correspondence: Hendrik Sutopo, Department of :stetrics and Gynecology, SanglahHospital, Denpasar$ Telephone< !#-=-#22/-, >mail
7/26/2019 Patient's profile with Hypertension in Pregnancy Patients
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aies orn from preeclamptic patients
has intrauterine growth restriction.$
Preeclampsia also increases the
perinatal mortality in de&eloped
countries up to 2 times higher#$
In Indonesia, the incidence of HIP
range from *$. to $2+ and it is still the
second cause of maternal death (.+),
after hemorrhagic post partum2$ 0rom
the pre&ious studies at Sanglah Hospital,
it was reported that the pre&alence of
HIP during !!. until !!2 was -$!-+
(mild P> $.-+, se&ere P> $2/+, and
eclampsia !$-#+)-, and during !!
until !!* was 2$*+ (mild P> $!*+,
se&ere P> $.-+, and eclampsia
!$*"+)/$ In #""/ at Sanglah Hospital, a
special study reported that the
pre&alence of se&ere preeclampsia was
#$+ andeclampsia was !$2+$
There are many risk factors for HIP,
especially preeclampsia, which can e
grouped into the following risk factorsSCTS
During years period of the study
*,-/" deli&eries were recorded and
found *.* or "$*+ cases of HIP, which
consists of gestational hypertension
#$+, chronic hypertension !$#"+,
mild preeclampsia #$*-+, se&ere
preeclampsia .$/!+, superimposed
preeclampsia !$.*+ and eclampsia!$+$
The pre&alence of HIP in the
maternal age 5! years was #*$./+, for
age !=*2 years was $!.+ and for the
age 4*2 years was #.$-+$ 3ost of the
cases (2*$#+) were primipaternality$ It
was re&ealed that ./$*+ from all cases
were nulliparous, followed y *$//+
were the second or third pregnancy, and
#*$""+ were the fourth or more
pregnancy$ 6ulliparous was the ma1ority
in each group for mild preeclampsia
(.-+), se&ere preeclampsia (./$.!+),
and eclampsia (-*$*+)$
2
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0rom all the cases, we otained
-"$!"+ patient had %67 fre8uency
more than . times, and /$"+ had
%67 fre8uency etween # to . times$
3ost of the cases had %67 at the
midwi&e (2$/-+), followed y :;Gyn
(.!$#+)$ :nly $"2+ of the cases who
ne&er check their pregnancy$ In e&ery
sugroup of HIP is almost entirely
dominated y the fre8uency of %67 4
.B, which are //$-+ for gestational
hypertension, #!!+ for chronic
hypertension, -+ for mild
preeclampsia, -.$/+ for se&ere
preeclampsia, #$2+ for SiP>, and -*,
**+ for eclampsia$
3ost of HIP cases at Sanglah
Hospital (-$*"+) were referral case
and the ma1ority referrer (.$+) was
midwi&e$ >specially for the eclampsia
group, the ma1ority referral cases came
from other hospitals (2$"+)$
3a1ority of the cases (2#$"!+)
were known to ha&e high lood pressureat term or 4*/ weeks$ 0or each
sugroup of HIP, which were
preeclampsia (/!+), superimposed
preeclampsia (.*$/2+), and se&ere
preeclampsia (2$-+) were known for
high lood pressure at the gestational
age etween 4=*/ weeks$ 0rom
se&ere preeclampsia group, the most of
systolic pressure ("#$*+) was in the
range of #-!=#/" mmHg and diastolic
pressure (/*$""+) was in the range of
##!=##" mmHg$ 0or eclampsia group,
-!+ systolic lood pressure was
otained at the range of #-!=#/" mmHg
and also -!+ diastolic lood pressure
was otained at the range of ##!=##"
mmHg$
The proportion of H>P
syndrome from all the HIP cases was
#2$/+$ The highest pre&alence of
H>P syndrome was found in
eclampsia group (.-$#2+), followed y
the se&ere preeclampsia (#$.+) and
superimposed preeclampsia (#$/2+)$
3ost of seiEures in eclampsia occured
during the antepartum period (!+)$
@hile the pre&alence of intrapartum and
postpartum seiEures was #!+,
respecti&ely$
3a1ority deli&ery mode of HIP
cases were spontaneous &aginal deli&ery
(*-$..+), followed y 7esarean Section
(7S) (*.$##+) and forceps eBtraction
(2$./+)$ >specially for the se&ere
preeclampsia group, the ma1ority of
deli&eries assisted y forceps eBtraction
(.-$.+) followed y 7S (.$//+)$ In
the eclampsia group, 2*$**+ were orn
y 7S$ :nly !$/+ of the HIP caseswere treated y conser&ati&e treatment
ecause of preterm gestational age$
0rom all HIP cases we otained the
rate infants irth weight less than 2!!
grams was *2$#.+$ 3ean while, the
pre&alence of ICGA was $+$ The
perinatal mortality rate was "$*+,
which consists of *$!+ intrauterine
fetal demise and -$#+ early neonatal
mortality$ @hen &iewed from the total
numer of perinatal deaths at Sanglah
Hospital, its otained that #*$2+ of
perinatal mortality associated with HIP$
0rom total ! cases of all maternal
mortality at Sanglah Hospital, it was
3
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found four cases of maternal mortality
related to HIP (!+)$ The four maternal
cases was #$#-+ from total HIP cases$
These four cases respecti&ely were (#)
se&ere preeclampsia with pneumonia
and sepsis, () eclampsia with multi=
organ failure, (*) eclampsia with solutio
placenta complicated y DI7, and (.)
eclampsia with complications of 7F%
(cerero&ascular accident)$ 0rom all
maternal deaths, 2!+ of them suffered
H>P syndrome$
0rom all HIP cases, it was otained
that patients length of stay in hospital
etween !=* days were 2$//+, .=/
days were *"$".+, and =#! days were
.$--+$ :nly $-+ were stay more than
#! days in hospital$
DIS7CSSI:6
0rom this study was found that the
pre&alence of HIP (included the mild
P>, se&ere P>, and eclampsia) washigher when compared with the
pre&ious years at Sanglah Hospital$
The difference of pre&alence can
e influenced y many factors such as
patient characteristics, genetic factors,
etter referral system and etter %67
8uality to screen HIP cases$ 0or patient
characteristics, it was influence y
maternal age 5! years or 4*2 years,
nulliparous, or primipaternality*,##,#$ 0or
genetic factors, currently in 'ali and
especially at Sanglah Hospital, many
patients came from other 'alinese
ethnic$ Since the patients were more
pluralistic, it needs further in&estigation
whether genetic factors (e$g certain
ethnic) influence the occurrence of HIP$
:n the other hand, the refferal system
could ha&e an important factor that
could alter the pre&alence rate of HIP$
There was a tendency that patients with
se&ere preeclampsia or eclampsia in
'ali will e referred to Sanglah Hospital
ecause of some reasons$ @e elie&ed
that these refferal system could increase
the proportion of HIP cases at Sanglah
Hospital, which in turn could affected
the data that we otained$
HIP cases mostly found in the age
group4 *2 years and was followed y
age group 5! years$ These result was
similar to most studies that show a =
shaped cur&e for relationship etween
maternal age and the incidence#.$ :lder
or younger maternal age mean higher
risk for HIP, ut higher incidence in
those who more than *2 years old*, #.$
'ased on the numer of pregnancies, we
otained the highest pre&alence of HIPwas in nulliparous and primipaternality$
These findings was also fit with the
literatures, where it was suspected
associate with immunological processes
ecause of eBposure to paternal
antigens*,#,#*$ High pre&alence rate of
HIP on primipaternality cases should e
gi&en more attention when perform
%67$ %ssociated with the risk for
preeclampsia, primipaternality should
e regarded as nulliparous#*, #.$
3ost patients with HIP had %67
fre8uency 9 .B$ 3ost of them checked
their pregnancy at midwife and then
followed y :;Gyn, and only $"*+
4
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cases were ne&er control their
pregnancy$ This suggests that the %67
program had a good co&erage and the
midwife was the primary health
pro&ider for %67$ 'ut in most cases
(2#$"!+) high lood pressure known
when gestational age at term$ @hile the
literature says the ma1ority of HIP cases
known in late pregnancy or near term#.$
This differentiation maye related to the
8uality of the %67 which was still
unoptimal$
%t Sanglah Hospital, the
pre&alence of H>P syndrome appears
to e related with se&erity of the
disease$ It otained from our study that
2!+ of maternal deaths were
accompanied y the presence of H>P
syndrome$
0rom total cases of HIP, the
ma1ority deli&ery mode were
spontaneous &aginal deli&ery (*-$..+),
followed y 7S (*.$##+) and forceps
eBtraction (2$./+), whereas only!$"+ with &acuum eBtraction$
>specially for se&ere preeclampsia, the
deli&ery mode ma1ority assisted y
forceps eBtraction (.-$.+)$ It seems
that we need further e&aluation to
determine the est deli&ery method for
HIP cases, especially for se&ere
preeclampsia and eclampsia, so
maternal and perinatal moridity rate
could e kept as low as possile$
3aternal mortality rates from HIP
cases at Sanglah Hospital was #$#-+$
%fter we counted from the total ! cases
of all maternal deaths in =years periode
of this study, maternal deaths related to
HIP was counted as many as . cases
(!+)$ This was consistent with the
literature in de&eloped countries, where
maternal mortality rate related to HIP
was etween #2=!+*,#,#.$
7:67CSI:6
The pre&alence of HIP at Sanglah
Hospital is higher than pre&ious years$
HIP cases were dominated y se&ere
preeclampsia$ The ma1ority of HIP
characteristic patients were nulliparous
and primipaternality$ 3ost of the cases
already had %67 y health care
pro&iders, which are midwi&es and
doctors$ Therey the 8uality of %67
might e necessary to e impro&ed y
earlier refferal system to referal hospital,
so the cases can e treated earlier$
A>0>A>67>S
#$ Aoerts 3, Pearson G, 7utler ,indheimer 3$ Summary of 6H'I
@orking Group on Aesearch on
Hypertension During Pregnancy$
Hypertension !!* .#< .*/=.2$
$ @orld Health :rganiEation$ Gloal
Program to 7on8uer Preeclampsia ;
>clampsia$ !!$ 7itied !#! %ug$
J %&ailale from , ed$ DanforthMs ostetrics and
gynecology$ #!th edition$
5
7/26/2019 Patient's profile with Hypertension in Pregnancy Patients
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Philadelphia< ippincott @illiams N
@ilkins, !!< 2=--$
.$ %uer , 7amoin , Guillonneau 0,
Aigourd F, 7heli ST, educ 3, et
al$ Serum Profile in Preeclampsia and
Intra=uterine Growth Aestriction
Ae&ealed y iTA%O Technology$
ournal of Proteomics !#! /*
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