الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Hypertensive disorders during pregnancy represent the second commonest cause of direct maternal death and complicate an estimated 5-10% of pregnancy.The cause involves inadequate cytotrophoblastic invasion of the myometrium,resulting in placental hypoperfusion and diffuse maternal endothelial dysfunction.Changes in angiogenic and antiangiogentic peptide profiles precede the onset of clinical preeclampsia.
Women with preeclampsia should be closely monitored and receive magnesium sulfate intravenously is severe features,HELLP syndrome,or eclampsia occur & definitive therapy is delivery of fetus.Hypertention in pregnancy increases future maternal risk of hypertention and cardiovascular disorders.
Topic of this study is: Maternal and perinatal outcome in women with hypertensive disorders of pregnancy at El-Mina maternity University hospital at 2019.
The present study reveals all patient with hypertention during pregnancy that has been managed at EL-Mina University Maternity Hospital from January 2019 to December 2019.This Hospital is apopulation-based facility, which provides primary,secondary and tertiary care for women of EL-Mina Governorate.
This study consist of five section preced by an introduction and followed by summary of the research and recommendation.
During the twelve monthes study period total 12377 women were delivered,out of them 1334 were diagnosed as cases of hypertensive disorders during pregnancy.
The aim of this study was to determine the frequency and distribuation of different types of hypertensive disorders of pregnancy,and to determine the impact of this potentially devastating disorders on maternal and fetal out comes at EL-Mina University Maternity Hospital which apopulation-based facility, that provides primary,secondary and tertiary care for women of EL-Mina Governorate.
Age,parity,gestational age,obstetric history,history of previous preeclampsia and clinical signs on admission were reported.full history taking,general abdominal and pelvic examination was done.Nearly all cases with SPET and eclampsia receving loding(4-6 gm) and maintenance dose(12-24 gm ) of magnesium sulfate.Antihypertensive drugs to most of cases ,nifidipine 10 mg was the primary antihypertensive drug used either alone or in combination with alpha methyle dopa 500mg.vitamin k 10mg and dexamethasone 12 mg is given if gestational age less than 37 weeks.
The effect of maternal age is one of the most important demographic factors that affects the incidence of HDP as 24.5 %14.7 of cases were below the age of 20 years, 37.4 % of cases were ranging from 20-35 years and 47.9 % of cases were more than 35 years.
The hospital received more pregnant women with hypertention coming from rural area 60.7 % than urban area 39.3 %.
Antenatal care was insufficient and ineffective as only 24.4 % of cases received more than>4 visits and only 75.5 % of patient were diagnosed and treated.
We found in the present study Gestational hypertention represents % of all cases,Mild preeclampsia 14 %,severe preeclampsia29 %.Imminent eclampsia 12.4 % , antepartum eclampsia 3.8 %,postpartum eclampsia 2.7 %,HELLP synsrome 1.3 %,Abrupto placenta 2.5 %,post partum haemorrage which is mainly dueto uterine atony 1.7 %,Renal failure 1.6 %,Hepatic failure 2.7 %, and maternal mortality represent .4 % of all cases.
Also we found preterm 40.1 % of newlyborn , Miscarriage 4.9%, IUFD 5.1 %,IUGR 5.9 %,early neonatal death 3.7 % and NICU admission was 13.1 % of babies.
Caesarean section represent 76.9 % of all cases. Regional (spinal) anathesia was the main route of anathesia while general endotracheal intubation anathesia was the main route in eclampsia.
As aconclusion, the frequency of hypertensive disorders of pregnancy is high in this study. The disorder is associated with high maternal and perinatal morbidity and mortality.The devastating effect of the condation could be prevented with close antenatal follow up.
Further prospective studies from different areas in the country are needed to establish the frequency ,clinical pattern and impact of this disorder to guide healthcare providers.
Based on the findings of this study we conclude:
Proteinuria isnot acorner stone in diagnosis of preeclampsia, some cases developed evidence of multiorgan involvement including thrombocytopenia,tenal dysfunction,hepatocellular necrosis,central nervous system perturbation,or pulmonary edema even in absence of proteinuria.
Lower limb edema isnot areliable sign as it present in most of cases and also in normal women.
Multiple pregnancy is significantly associated with increase risk of gestational hypertention and preeclampsia.
Antenatal care should be regular,computerized on database which include all women in Egypt to help us in follow up and provide us with relevant and accurate history of the patient to reach to optimum diagnosis.
DM and hypertention have great associated with hypertention during pregnancy so such patient should be carefully monitored.
Improving antenatal and emergency obstetric and neonatal care is mandatory to improve outcome.
Clear protocols for management of hypertention in pregnancy at levels of health care are required for better maternal as well as perinatal outcome.
Maternal mortality is rare if patients are managed properly.
The neonatal outcome has been linked to neonatal intensive care facilities and gestational age at birth,NICU remains akey requirement in management of HDP, but this service is expensive and limited ,particulary in developing countries.
Recommendation:
Antenatal care is the strategy while intranatal care is the tactic to reduce
Maternal morbidity and subsequent mortality in primary health care units and hospital outpatient clinics.
More attention to BP measurment and urine analysis to all PG cases especially after 34 weeks.
The purpose of antenatal care is not only to maintain the physiological profile of pregnancy,but also to identify patients with risk factors, early diagnosis,which allows for appropriate management and as result reduce maternal and fetal morbidity and mortality.
Preconceptional counseling should be offered where the events that occurred,any risk factors and any preventive therapies can be discussed.
Public health awareness and education of women can help to improve maternal and neonatal prognosis.
In addation to nulliparity,risk factors include young age,multiple pregnancy,DM and early third trimester preeclampsia in previous pregnancy.
Such patients should receive greater attention.The development of hypertention and increasing edema increase the concern so that patients should be managed more carefully intervals,preferably in ahigh risk clinic.
There is evidence that availability to emergency transportation to afacility is efficacious in reducing overall morbidity and mortality .Ideally,every admitted case should have afile including detailed information about all the services provided. The registration process would be rendered easier with the implementation of computer- based systems that should incorporate interdepartmental exchange of information.
U/S evulation by senior staff members are recommended to all cases.
Management of emergency admissions should involve senior obstetric and anesthetic staff,who isnot only participate in term of their experience but also provide continuous supervision and,whenever necessary, guide to the trainees.
Development and implementation of practice guide lines and management protocol for cases of severe preeclampsia and eclampsia.
Eclampsia, along with many other maternal emergencies requires admission to an intensive care unit,where the combined abilities of obestetricians ,anethetics and other blend together to provide continuous maternal and fetal monitoring, cardiac,respiratory,renal,hepatic and neurological supportive treatment.
Further prospective studies and meticulous documentation of the findings from different governorate are needed to establish the incidence ,clinical pattern and the impact of this proplem in order to guide healthcare planning.
Alternative strategies in the form of early detection,monitoring ,and supportive care might be the best ways to help both mothers and babies.