Perinatal outcomes, blood pressure patterns and risk assessment of superimposed preeclampsia in mild chronic hypertensive pregnancy.
OBJECTIVE
Assessment of perinatal outcomes, blood pressure (BP) patterns and risk of superimposed preeclampsia in a population with mild chronic hypertension.


METHODS
We investigated 223 pregnant women with mild chronic hypertension and 200 controls. Twenty-four-hour BP monitoring longitudinally in pregnancy and Doppler assessment of uterine arteries at 24 weeks' gestation were performed. Perinatal outcomes were recorded.


RESULTS
Superimposed preeclampsia occurred in 28.4% of hypertensive women, with an increased rate of small-for-gestational age babies (30.7% versus 8.9%), a lower birth weight (2587.75+/-832.97 versus 3167.35+/-536.3; p < 0.001) and a higher rate of caesarean sections (69.2% versus 35.5%) than controls. According to the ROC curve, the mean 24-h blood pressure (diastolic 78 mmHg [S.E.: 0.95; SP: 0.89] and systolic 121 mmHg [S.E.: 0.88; SP: 0.92]) and the mean resistance index of the uterine arteries of 0.52 (S.E.: 0.69; SP: 0.87) are better prognostic values for predicting superimposed preeclampsia.


CONCLUSIONS
In women with chronic hypertension in the second trimester 24-h blood pressure monitoring and Doppler velocimetry of the uterine artery are able to detect those at risk of superimposed preeclampsia. In women with circulatory adaptation to pregnancy, a good perinatal outcome is expected with proper obstetric care.
Giannubilo
Stefano Raffaele
SR
Department of Obstetrics and Gynecology, Marche Polytechnic University at Salesi Hospital, Via Corridoni 11, 60123 Ancona, Italy. s.giannubilo@univpm.it
Dell'Uomo
Bernardo
B
Tranquilli
Andrea L
AL
D000328:Adult; D001724:Birth Weight; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007223:Infant; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D017078:Laser-Doppler Flowmetry; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging