A retrospective observational study on HDP gestosis score as a predictor of PIH

ISSN Print – 2454-2334; ISSN Online – 2454-2342 DOI - 10.21276/obgyn.20252024.11.1.21 RESEARCH ARTICLE A retrospective observational study on HDP gestosis score as a predictor of PIH Sangeeta Pahwa, Simran Kakkar Corresponding author: Dr Sangeeta Pahwa, Professor and HOD, Department of Obstetrics and Gynaecology , SGRDIMSR, Amritsar, Punjab, India; Email – Distributed under Attribution-Non Commercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Objectives: To assess the association of various risk factors enclosed in HDP gestosis score with the development of pregnancy induced hypertension. Methodology: This study was done at Sri Guru Ram Das Institute of Medical sciences and Research on patients who developed PIH (Pregnancy induced hypertension) from January 2020 to December 2020. Patients were analysed according to gestosis score given by Indian gestosis association. Based on elaborate history, clinical examination and investigations gestosis score was calculated. Results: Factors that have been found to have statistical significance in the development of HDP in the terms of p value< 0.05 are maternal anemia and primigravida. There were 17 patients who developed preeclampsia and 4 patients developed eclampsia. The major risk factors in patients with eclampsia were primigravidas with mild - moderate anaemia with short duration of co - habitation. Maximum patients who developed preeclampsia and eclampsia had gestosis score of >3 but there were 2 such patients who had gestosis score of 2 but still developed eclampsia. Patients who developed PIH, 11 patients have gestosis score of <3, 39 patients have gestosis score >3. One eclamptic patient with gestosis score of 4 suffered subacute intracranial haemorrhage and 1 preeclamptic patient with gestosis score 5 developed post partum cardiomyopathy. Conclusion: Adolescent primigravidas are more prone for eclampsia, the severe form of disease. Avoiding early marriage and explaining need for contraception to this group can reduce adolescent pregnancies and its dreaded complications. Gestosis score can be used as an effective predictor of PIH, as it is simple and costeffective. Keywords: Gestosis, HELLP, post partum cardiomyopathy, subacute intracranial haemorrhage, primigravida, maternal anaemia. Pregnancy induced hypertension (PIH) is a common and important medical problem. It complicates about 5% of all pregnancies worldwide1, ranks second to haemorrhage (27%) as a specific direct cause of maternal death. In the current scenario, preeclampsia/ eclampsia related morbidity and mortality appears to be increasing over the years. Thus, necessary steps have to be taken to hasten the reduction of maternal mortality. HDP includes: 2 Gestational hypertension: Blood pressure ≥ 140/90 mmHg, detected beyond 20 weeks of gestation and returns to normal within 42nd postpartum day and is not associated with any other features of preeclampsia. Chronic hypertension: Known case of hypertension or a case of hypertension detected before 20 weeks of gestation in absence of neoplastic trophoblastic disease and multiple pregnancies. Preeclampsia: It is a multisystem inflammatory disorder beyond 20 weeks of pregnancy with significant proteinuria characterized by de novo onset of hypertension (BP ≥ 140/90 mmHg). More recently, atypical variant of preeclampsia is recognized which is accompanied by neurological, hematological, hepatic, renal manifestations or fetal growth restriction, in absence of proteinuria. Eclampsia: It is occurrence of seizures in association with Received: 22nd January 2022, Peer review completed: 10th May 2022, Accepted: 10th August 2022. Sharma R, Sahai A. A study to analyze and correlate histopathology of hysterectomy specimen, ultrasonography and clinical presentation in perimenopausal women with abnormal uterine bleeding. The New Indian Journal of OBGYN. 2024; 11(1): 113 - 17. The New Indian Journal of OBGYN. 2024 (July-December);11(1) preeclampsia. It can also occur as atypical eclampsia. Superimposed preeclampsia: it is the occurrence of preeclampsia in women with chronic hypertension. Keeping the disease burden in view, universal screening is recommended by FIGO (International Federation of Gynaecology and Obstetrics).3 FIGO recommends one step procedure for preeclampsia screening. This includes maternal risk factors, measurement of mean arterial pressure (MAP), serum placental growth factors (PLGF) and uterine artery pulsatility index (UTPI) 4, 5, due to lack of resources the baseline screening test should be a combination of maternal risk factors with MAP. Currently, approach to screening for preeclampsia was developed by National Institute for Health and Clinical Excellence (NICE) and American College of Obstetrics and Gynaecology (ACOG) to identify risk factors from maternal demographic characteristics and medical history 6. NICE and ACOG guidelines have a good detection rate of early onset preeclampsia where the resources are limited and nonavailability of biomarkers is an issue. Also, a simple structured risk model has been restructured as HDP Gestosis Score by Indian Gestosis Association7 for Indian subcontinent (table 1). The mild, moderate and severe risk factors for Indian population are quantified as 1, 2 and 3 respectively. Total of ≥3 score, pregnant women is labelled as “At Risk of HDP”. Thus, our study aims to correlate the association of various parameters of HDP - Gestosis score with the development of hypertensive disorder of pregnancy such that vigilant monitoring of such patients can be possibly done and to spread awareness regarding such high risk factors. This may further help in educating poor socioeconomic strata as well as educated strata thus reducing the maternal mortality and morbidity related to hypertensive disorder of pregnancy. Aims and objectives:  To determine the HDP-Gestosis Score in patients with hypertensive disorders of pregnancy.  To correlate severity of HDP with gestosis score calculated.  To determine the maternal and fetal outcomes in patients who developed hypertensive disorder of pregnancy. Materials and methods This is a retrospective observational study done at Sri Guru Ram Das Hospital, Amritsar, conducted for a period of 1 year (January 2020 - December 2020). 50 patients developed hypertensive disorders of pregnancy. Inclusion criteria 1. All pregnant females that developed hypertensive disorder of pregnancy that includes: preeclampsia, eclampsia, HELLP syndrome, gestational hypertension, and chronic hypertension superimposed preeclampsia. 2. All booked and unbooked cases delivered at or outside Sri Guru Ram Das Hospital, Amritsar. Table 1: Risk factors Risk factor Age >35 years Age <19 years Maternal anaemia Obesity (BMI>30) Primigravida Short duration of marriage (cohabitation) Women born as small for gestational age Family history of cardiovascular disease Polycystic ovary syndrome Interpregnancy interval >5 years Conceived with ART (IVF/ICSI) (...truncated)