CLINICAL PROFILE AND OUTCOMES OF HYPERTENSIVE DISORDERS OF PREGNANCY IN A TERTIARY CARE HOSPITAL: A RETROSPECTIVE STUDY
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Keywords
Hypertensive disorders of pregnancy; pre-eclampsia; eclampsia; maternal mortality; perinatal outcome; Bihar; RDJMMCH; Muzaffarpur
Abstract
Background: Hypertensive disorders of pregnancy (HDP) constitute a spectrum of conditions—gestational hypertension, pre-eclampsia, eclampsia, and superimposed pre-eclampsia on chronic hypertension—that remain the foremost cause of maternal and perinatal morbidity and mortality in low-resource settings. Bihar, with its persistently high maternal mortality ratio and low institutional delivery rates outside district headquarters, presents a uniquely challenging epidemiological environment. RDJMMCH, Muzaffarpur, as the primary obstetric referral center for north Bihar, receives a disproportionately high burden of severely decompensated HDP cases transferred from peripheral and sub-district health facilities.
Objectives: To characterize the clinical profile and maternal–perinatal outcomes of HDP across its subcategories in patients admitted to RDJMMCH during January–July 2023.
Methodology: A retrospective observational study was conducted over seven months. Case records of 248 HDP patients satisfying inclusion criteria were reviewed. HDP categories were defined per ACOG 2020 guidelines.[8] Statistical analysis was performed using SPSS v25.0 and Microsoft Excel 2019.
Results: The HDP incidence was 7.0% of total deliveries (248/3602). Pre-eclampsia (71, 28.6%) and gestational hypertension (62, 25.0%) were the most frequent categories. Eclampsia (31, 12.5%) carried the highest maternal complication rate: ICU admission 71.0%, perinatal mortality 25.8%, and maternal death 12.9%. Combined tobacco-alcohol exposure showed no significant association (p=0.287 for rural residence), but unregistered antenatal care was significantly more common in eclampsia (58.1%, p=0.003). Preterm birth affected 83.9% of eclampsia deliveries. Magnesium sulphate was administered in all eclampsia cases (100%) and 78.9% of pre-eclampsia cases.
Conclusion: HDP imposes a severe and subtype-dependent burden at RDJMMCH. Eclampsia, though less frequent than pre-eclampsia, drives disproportionate maternal and perinatal mortality—attributable largely to late referral, unregistered ANC, and limited access to specialist obstetric care from rural north Bihar and the adjoining Muzaffarpur–Sitamarhi–Sheohar corridor.
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Dr. Rashmi Raginee
Assistant Professor, Department of Obstetrics & Gynaecology, RDJMMCH, Turki, Muzaffarpur, Bihar, India
Dr. Alok Pritam
Assistant Professor (Statistics), Department of Community Medicine, Late Shree Lakhiram Agrawal Memorial Medical College, Raigarh, Chhattisgarh, India
, Dr. Randhir Kuma
Professor & Head, Department of Community Medicine, LBKMCH, Saharsa, Bihar, India
