Doença hipertensiva gestacional: perfil das gestantes e repercussões sobre o parto e período perinatal em um hospital escola do sul do país

Abstract

Pregnancy usually presents a course without complications. However, in some cases, the development of pathologies inherent to pregnancy or the presence of previous pathologies may occur, increasing the risk of complications. Hypertensive diseases during pregnancy represent significant complications, contributing to high maternal, fetal and neonatal morbidity and mortality. The University Hospital of Santa Maria (HUSM), a regional reference for prenatal care of high-risk pregnant women, presents an ideal setting for the study of the routes of delivery, as well as gestational and perinatal outcomes, in patients with Gestational Hypertensive Disease. This study aims to characterize the epidemiological profile of parturients, evaluate prenatal and delivery data, including indications for birth, route of delivery and its complications, as well as data on the newborn. A quantitative, observational and cross-sectional study was carried out based on interviews with postpartum women and on the review of the medical records of hypertensive pregnant women without comorbidities who gave birth at the HUSM, Santa Maria, RS, between January 2017 and June 2018. A descriptive analysis of the variables and the association between them was verified by the chi-square test, with a significance level of 5%. This study complied with the ethical precepts contained in CNS Resolution n.466/2012 and was approved by the UFSM Ethics Committee (opinion n° 2,814,895 and CAAE 1 59366116.5.0000.5346). During the analysed period, there were 3156 births at the HUSM, with 31.1% in hypertensive pregnant women. The study included 1904 pregnant women, 981 (51.5%) with hypertension and 923 (48.5%) without comorbidities. Of the hypertensive women, 42.4% had pre-eclampsia (PE), 5.8% had PE superimposed on chronic hypertension (SAH), 12.0% had chronic SAH and 39.8% had gestational SAH. SAH was associated with maternal age equal to or greater than 35 years, obesity, nulliparity or multiparity, and prenatal care at a high-risk service with at least 6 prenatal appointments. Labor was predominantly spontaneous in patients without comorbidities (58.1%) and induced in hypertensive patients (42.7%), p<0.001. Of the induced deliveries, there was an association with vaginal delivery in pregnant women without comorbidities and cesarean delivery in hypertensive women (p<0.001). An association was observed between hypertensive pregnant women and complications in labor (p<0.001), vaginal delivery (P=0.011) and with birth weight <2500g (p<0.001). Newborns of hypertensive mothers were associated with neonatal complications (13,9%), need for resuscitation (3,4%) and admission to the neonatal intensive care unit (10,5%) (p<0.001). Through the present study, it was possible to elaborate an updated panorama of the morbidity profile, gestational outcomes and perinatal outcomes in patients with Gestational Hypertensive Disease treated at the HUSM, compared to pregnant women without comorbidities. Hypertensive diseases during pregnancy increase the risk of gestational and perinatal morbidity and mortality, increase the rate of induced deliveries and caesarean sections, requiring specialized care for these pregnant women in order to reduce unfavorable maternal and fetal outcomes.