Characteristic of Pregnant Woman with Hypertension In Obstetric and Gynecological Department Hasan Sadikin General Hospital Bandung in 2013

Characteristic of Pregnant Woman with Hypertension In Obstetric and Gynecological Department

Hasan Sadikin General Hospital Bandung in 2013

Andre Ruggery Ichwan,1 Rubin S. Gondodiputro,2

Anggraini Widjadjakusuma3

1Faculty of Medicine, 2Departement of Internal Medicine, 3Departement of Epidemiology and Biostatistics

Universitas Padjadjaran/ Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaJalan Raya Bandung-Sumedang Km. 21, Jatinangor-Bandung

1. Andre Ruggery IchwanFaculty of Medicine, Universitas PadjadjaranJalan Raya Bandung-Sumedang Km.21Jatinangor-BandungPhone : +6281285247252Email : [email protected]

2. Rubin S. Gondodiputro, dr., SpPD-KGHDepartement of Internal Medicine, Faculty of Medicine, Universitas PadjadjaranJalan Pasteur No.38Bandung 40161Phone : +62811228975Email : [email protected]

3. Anggraini Widjadjakusuma, dr., SpPDDepartement of Epidemiology and Biostatistics, Faculty of Medicine, Universitas PadjadjaranJalan Prof. Eyckman No.38Bandung 40161Phone : +6283821554555Email : [email protected]

Characteristic of Pregnant Woman with Hypertension In Obstetric and Gynecological Department

Hasan Sadikin General Hospital Bandung in 2013

Andre Ruggery Ichwan1, Rubin S. Gondodiputro2, Anggraini Widjadjakusuma3

1Faculty of Medicine,2Departement of Internal Medicine3Departement of Epidemiology dan Biostatistic

Universitas Padjadjaran/Hasan Sadikin General Hospital Bandung

AbstractBackground: Hypertension can lead to maternal death because of complication such as heart failure, kidney failure and intracerebral hemorrhage. It is important to be aware of hypertension in pregnant woman with certain characteristics, in order to reduce maternal death. This study aimed to identify the characteristics of pregnant woman with hypertension.Methods: This descriptive cross-sectional study involves 150 medical record of pregnant woman with hypertension hospitalized in Obstetrics and Gynecology Department of Dr. Hasan Sadikin General Hospital Bandung in 2013 selected using systematic random sampling and characteristics of patient with different type of hypertension was observed.Result: Preeclampsia is seen on 37% subject, in which 75% are 18-35 years old, 66% multiparous and 91.1% have no history of hypertension. Only 6% of the subject are eclampsia, all of them are 18-35 years old, 66% multiparous and 88.9% have no history of hypertension. Gestational hypertension is seen on 27% of subjects, 72.5% are 18-35 years old and 72.5% are multiparous. Majority of subject with chronic hypertension (65.4%) are 35 years or older and all are multiparous. In superimposed preeclampsia there is no difference between both age group, and 94.7% multiparous. Blood pressure of eclampsia and superimposed preeclampsia are higher than other types of hypertension.Conclusion: Preeclampsia and gestational hypertension occurred more often than other types of hypertension. Almost in all types of hypertension, most subjects are 18-35 years old, multiparous, and blood pressure of eclampsia and superimposed preeclampsia patients are higher.Keywords: characteristic, hypertension, pregnancy

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Karakteristik Ibu Hamil dengan HipertensiDi Departemen Ilmu Kebidanan dan Penyakit Kandungan

RSUP Dr. Hasan Sadikin Bandung Pada Tahun 2013

Andre Ruggery Ichwan1, Rubin S. Gondodiputro2, Anggraini Widjadjakusuma3

1Fakultas Kedokteran,2Departemen Ilmu Penyakit Dalam 3Departemen Epidemiologi dan Biostatistika

Universitas Padjadjaran/RSUP Dr. Hasan Sadikin Bandung

AbstrakLatar Belakang: Kematian maternal dapat disebabkan oleh komplikasi hipertensi seperti gagal jantung, gagal ginjal maupun perdarahan intraserebral. Hipertensi pada ibu hamil dengan karakteristik tertentu penting untuk diwaspadai agar dapat menurunkan angka kematian ibu. Penelitian ini bertujuan untuk mengidentifikasi karakteristik ibu hamil dengan hipertensi.Metode: Studi deskriptif potong lintang ini melibatkan 150 rekam medis ibu hamil dengan hipertensi yang dirawat di Departemen Ilmu Kebidanan dan Penyakit Kandungan RSUP Dr. Hasan Sadikin Bandung pada tahun 2013, diambil secara systematic random sampling.Hasil: Didapatkan 37% pasien preeklamsia, 75% berusia 18-35 tahun, 66% multipara, 91.1% tidak ada riwayat hipertensi. Terdapat 6% kasus eklamsia, semuanya berusia 18-35 tahun, 66% multipara, 88.9% tidak memiliki riwayat hipertensi. Terdapat 27% pasien hipertensi gestasional, 72.5% berusia 18-35 tahun, 72.5% multipara. Pasien hipertensi kronis 65.4% berusia 35 tahun atau lebih, seluruhnya multipara. Pada pasien superimposed preeklamsia tidak ada perbedaan usia yang mencolok, 47.4% berusia 18-35 tahun, 52.6% berusia 35 tahun atau lebih, 94.7% multipara. Tekanan darah pasien eklamsia dan superimposed preeklamsia lebih tinggi daripada hipertensi lainnya.Simpulan: Preeklamsia dan hipertensi gestasional lebih banyak terjadi dibandingkan jenis hipertensi lainnya. Hampir pada seluruh jenis hipertensi, pasien berusia 18-35 tahun, multipara. Tekanan darah lebih tinggi pada pasien eklamsia dan superimposed preeklamsia.Kata Kunci: hipertensi, ibu hamil, karakteristik

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Introduction

According to surveillance conducted by WHO, 16% maternal death in the

world was caused by hypertension.1 Especially in Indonesia, hypertension in

pregnancy caused 3,335 maternal death in 2010.2 The presence of complication

can be one of the reason for the death. Usually, hypertension in pregnancy was

complicated by seizure (eclampsia), heart failure, kidney failure, even

intracerebral hemorrhage.3,4 Patients with hypertension in pregnancy can also

affected by subsequent cardiovascular condition after pregnancy that can lead to

death.5 High number of mortality rate and decent number of possible complication

shows the importance of accurate complication prevention to hypertension in

pregnancy. Good prevention can be done if characteristics of pregnant woman

with hypertension is identified properly. This study aims to identify characteristics

of pregnant woman with hypertension.

Methods

This descriptive cross-sectional study was conducted from August until

October 2014 in Obstetric and Gynecological Department Hasan Sadikin General

Hospital Bandung. Data was taken from medical records of pregnant woman with

hypertension. Medical records was taken from the center Medical Records

section. The use of medical records have been approved by Ethical Health

Research Committee of Hasan Sadikin General Hospital Bandung. Population of

this study was pregnant woman hospitalized in Obstetric and Gynecological

Department Hasan Sadikin General Hospital Bandung.

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Criteria for inclusion were pregnant woman with systolic blood pressure

≥140 mmHg or diastolic blood pressure ≥90 mmHg, while the criteria for

exclusion were patients with age under 18 or incomplete medical records. Sample

collected with systematic random sampling from 392 pregnant woman with

hypertension and unfortunately only 150 data is eligible for further analysis due to

many missing medical records.

Data taken from medical records include characteristics such as age,

educational level, history of hypertension, history of miscarriage, parity, blood

pressure level, and proteinuria. Characteristic of patient with different type of

hypertension was then observed. Collected data was analyzed using statistic

software and Microsoft Excel, and presented in the form of table.

Results

Preeclampsia is the most common type of hypertension in pregnant

woman (37%), followed by gestational hypertension (27%). Only 6% were

suffering from eclampsia.

Table 1 Types of hypertension in pregnant woman

Types Amount (n) Frequency (%)

Preeclampsia 56 37%Gestational Hypertension 40 27%Chronic Hypertension 26 17%Superimposed preeclampsia 19 13%Eclampsia 9 6%

Total 150 100%

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Table 2 showed that of the 56 patients with preeclampsia, 42 patients

(75%) were aged 18-35 years. Distribution of educational level in preeclampsia

patients seem evenly. A total of 37 multiparous patients, 32 of them (57.2%) had a

number of pregnancies two to four. Sixty four percent is classified as hypertension

grade two. Only one patient was negative for proteinuria. Most (87.5%)

preeclampsia patients had no history of abortion. Almost all patients (91.1%) did

not have a prior history of hypertension.

Characteristics Amount (n=56) Frequency (%)

Age18–35>35

4214

7525

EducationElementaryJunior HighSenior HighBachelor

1716185

30.428.632.18.9

ParityNuliparaMultipara (2-4)Grande Multipara (≥5)

19325

33.957.28.9

Hypertension GradeGrade 1Grade 2

2036

35.764.3

Proteinuria(-)(+1)(+2)(+3)(+4)

12516131

1.844.628.623.21.8

Miscarriage HistoryYesNo

749

12.587.5

History of HypertensionYesNo

551

8.991.1

Table 2 Characteristics of preeclampsia patients

Table 3 shows the characteristics of patients with gestational hypertension.

It appears that from 40 patients, 29 (72.5%) were aged 18-35 years. As many as

45% of the patients’ education level is junior high school and most (65.5%) were

multiparous with the number of pregnancies two to four. A total of 77.5% patients

classified as grade one hypertension. Almost all patients, (37 patients, 92.5%) had

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negative proteinuria. Only one from five patients (20%) had a history of abortion.

None of the patients had a previous history of hypertension.

Table 3 Characteristics of gestational hypertension patientsCharacteristics Amount (n=40) Frequency (%)

Age18–35 >35

2911

72.527.5


818122

2045305

ParityNuliparaMultipara (2-4)Grande Multipara (≥5)

11263

27.5657.5


319

77.522.5

Proteinuria(-)(+1)(+2)(+3)(+4)

3721--

92.55

2.5--


832

2080


-40

-100

Table 4 shows that of 26 patients with chronic hypertension, 17 (65.4%)

were older than 35 years. The education of 42.3% patients was elementary school.

All patients had more than one pregnancy, 53.8% multiparous and 46.2% grande

multipara. A total of 73.1% patients were classified as grade two hypertension.

All patients had negative proteinuria. Most of the patients (73.1%) had no history

of miscarriage. All patients had a history of hypertension.

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Table 4 Characteristics of chronic hypertension patientsCharacteristics Amount (n=26) Frequency (%)

Age18–35 >35

917

34.665.4


1178-

42.326.930.8

-Parity

NuliparaMultipara (2-4)Grande Multipara (≥5)

-1412

-53.846.2


719

26.973.1

Proteinuria(-)(+1)(+2)(+3)(+4)

26----

100----


719

26.973.1


26-

100-

Table 5 shows that the age of patients with superimposed preeclampsia

was similarly distributed. No tendency of certain educational level in all patients

with superimposed preeclampsia. There were 12 multiparous patients (63.2%) and

6 grande multipara patients (31.6%). Most of the patients (84.2%) were

hypertension grade two. Eleven of 19 patients had negative proteinuria. Most of

the patients (68.4%) had no history of abortion. All patients had a previous history

of hypertension.

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Table 5 Characteristics of superimposed preeclampsia patientsCharacteristics Amount (n=19) Frequency (%)

Age18–35 >35

910

47.452.6


577-

26.336.836.8

-Parity


1126

5.363.231.6


316

15.884.2

Proteinuria(-)(+1)(+2)(+3)(+4)

1135--

57.915.826.3

--


613

31.668.4


19-

100-

Table 6 shows that the all eclampsia patients aged 18-35 years. There was

no particular inclination towards educational level. The majority (66.67%) were

multiparous, all patients classified as hypertension grade two and all patients had

proteinuria (positive 1 or 2) with the amount of each is almost the same. All

eclampsia patients had no history of miscarriage and most (88.9%) did not have a

prior history of hypertension.

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Table 6 Characteristics of eclampsia patientsCharacteristics Amount (n=9) Frequency (%)

Age18–35 >35

90

1000


234-

22.233.344.5

-Parity


36-

33.366.7

-Hypertension Grade

Grade 1Grade 2

-9

-100

Proteinuria(-)(+1)(+2)(+3)(+4)

-45--

-44.455.6

--


-9

-100


18

11.188.9

Discussion

In this study, the most common types of hypertension in pregnant women

was preeclampsia (37%) followed by gestational hypertension (27%), chronic

hypertension (17%), superimposed preeclampsia (13%) and only 6% were

suffering from eclampsia. Percentage of gestational hypertension and

preeclampsia in this study were similar compared to studies conducted by Roberts

et al. which stated that 9.8% of the study subjects had hypertension in pregnancy,

4.3% had gestational hypertension and 4.2% had pre-eclampsia.6

Most of preeclampsia patients aged 18-35 years (75%), 87.5% had no

history of abortion and all of them had no history of hypertension (91.1%). This

result was similar with the research conducted by Poon et al. which stated that the

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average age of patients with preeclampsia was approximately 31-32 years.7 In this

study, most patients were multiparous (57.2%), that was known to be a risk factor

for preeclampsia according to a study conducted by Papageorghiou et al.8

However, studies conducted by Roberts6 et al., Saftlas9 et al. and Duckitt10 et al.

revealed that nulliparous was also a risk factor for preeclampsia. A total of 36

from 56 patients (64.3%) were classified as hypertension grade two. Most

preeclampsia patients did not have a history of abortion. According to a study

conducted by Trogstad11 et al. and North12 et al., spontaneous or induced abortion,

have a protective effect against pre-eclampsia

Most of gestational hypertension patients aged 18-35 years (72.5%), it is

similar to a study conducted by Poon et al. who earn an average of gestational

hypertension patients aged 33 years.7 Two patients were excluded because the age

was under 18. Most patients (65%) were multiparous and 80% did not have a

history of abortion. These findings differ from research conducted by Poon et al.

which stated that nulliparous was a risk factor for gestational hypertension.7 Most

gestational hypertension patients (77.5%) was classified as hypertension grade 1.

There were 5% of patients with proteinuria (+1) and 2.5% proteinuria (+2). This

may be due to other diseases that already existed but cannot be known because

there was no information in the medical record.

In patients with chronic hypertension, 65.4% were over 35 years old, all

multiparous and most did not have a history of miscarriage (73.1%). Most patients

(73.1%) classified as hypertension grade two and all proteinuria test results were

negative.

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The age distribution of superimposed preeclampsia patients was similar

for 18–35 years of age (47.4%) and 35 years older (52.6%). Patients were likely to

be multiparous (63.2%) and had no history of miscarriage (68.4%). Most patients

(84.2%) classified as hypertension grade two. A total of 57.9% of patients had

negative proteinuria.

All of eclampsia patients aged 18-35 years, 66% multiparous, none had a

history of miscarriage and 88.9% had no prior history of hypertension. This result

was in contrast to a study conducted by Liu et al.13 who showed that many

eclampsia occured in nulliparous women. All eclampsia patients classified as

hypertension grade two and all had proteinuria.

Preeclampsia and gestational hypertension occured more frequently than

other types of hypertension in pregnant women. This study found that the

characteristics of pregnant women with hypertension were mostly 18-35 years

old, multiparous and had no history of miscarriage. In pregnant women with age

more than 35 years, most had a history of hypertension. Although did not have a

previous history of hypertension, patients could be exposed to preeclampsia and

eclampsia. In addition, patients with eclampsia and superimposed preeclampsia

tends to have higher blood pressure than patients with other type of hypertension

in pregnancy.

Limitations of this study were that some of the medical record were

missing and incomplete. Further study is needed to know the relationship between

the characteristics of pregnant women with the risk of developing hypertension in

pregnancy. The results of this study are expected to be useful in increasing public

awareness and health workers against hypertension in pregnant women, especially

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in patients under 35 years old and multiparous. In addition, patients without a

history of miscarriage or hypertension remains to be observed because they were

still having a possibility for developing hypertension in pregnancy.

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Killer, Global Public Health Crisis.2013 [cited 2014 February 17th]:[p.40].

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2013. In: Kementerian Kesehatan Republik Indonesia, editor.

Indonesia.2013.

3. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY.

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4. Dai X, Diamond JA. Intracerebral Hemorrhage: A Life‐threatening

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Hypertensive disorders in pregnancy: a population-based study. Med J

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Characteristic of Pregnant Woman with Hypertension In Obstetric and Gynecological Department Hasan Sadikin General Hospital Bandung in 2013