title: Maternal and fetal outcome in women with hypertensive disorders of pregnancy: the impact of prenatal care.
abstract: BACKGROUND
  Hypertensive disorders of pregnancy (HDP) are the most important cause of maternal and fetal death and pregnancy complications in Latin America and the Caribbean.
  
  
  OBJECTIVE
  The objective of this study was to characterize the epidemiological profile of women with HDP admitted to a Brazilian tertiary reference hospital, and to evaluate maternal and fetal outcome in each HDP and the impact of prenatal care on the maternal and fetal outcome.
  
  
  METHODS
  HDP in 1501 women were classified according to usual definitions as chronic hypertension (n = 564), pre-eclampsia (n = 579), eclampsia (n = 74) and pre-eclampsia/eclampsia superimposed on chronic hypertension (n = 284). Adverse maternal and fetal outcomes registered as maternal death and near miss and fetal outcomes documented as stillbirth, neonatal death and newborn respiratory complications were compiled. Prenatal care was classified as complete (⩾ 6 visits), incomplete (< 6 visits) or not done.
  
  
  RESULTS
  Women with eclampsia were younger (15 years), 68% were on their first pregnancy, had higher blood pressure, higher mortality and greater number of near miss cases and their children had lower birth weight, higher intra-uterus and neonatal mortality, and more respiratory distress. Women with pre-eclampsia/eclampsia superimposed on chronic hypertension and their fetuses had intermediate outcome and those with chronic hypertension and pre-eclampsia the better outcome among those with HDP. Women who had incomplete prenatal care or prenatal not done had progressive higher mortality rates and greater frequency of near miss cases, and their children had higher mortality rates.
  
  
  CONCLUSIONS
  In a tertiary reference hospital, eclampsia and chronic hypertension superimposed on pre-eclampsia are associated with a worst outcome for mothers and fetuses, whereas complete prenatal care is associated with a better maternal and fetal outcome in HDP.
authors.affiliation: Faculdade de Ciências Médicas e da Saúde da PUC/SP, Brazil.
authors.forename: Isabela Roberta Cruz
authors.initials: IR
authors.lastname: Barbosa
authors.affiliation: Faculdade de Ciências Médicas e da Saúde da PUC/SP, Brazil.
authors.forename: Wesley Bruno Merencio
authors.initials: WB
authors.lastname: Silva
authors.affiliation: Faculdade de Ciências Médicas e da Saúde da PUC/SP, Brazil.
authors.forename: Grace Sanches Gutierrez
authors.initials: GS
authors.lastname: Cerqueira
authors.affiliation: Faculdade de Ciências Médicas e da Saúde da PUC/SP, Brazil.
authors.forename: Neil Ferreira
authors.initials: NF
authors.lastname: Novo
authors.affiliation: Faculdade de Ciências Médicas e da Saúde da PUC/SP, Rua Joubert Wey 290, Sorocaba, 18047594, Brazil faalmeida@globo.com.
authors.forename: Fernando Antonio
authors.initials: FA
authors.lastname: Almeida
authors.affiliation: Faculdade de Ciências Médicas e da Saúde da PUC/SP, Brazil.
authors.forename: Joe Luiz Vieira Garcia
authors.initials: JL
authors.lastname: Novo
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D004461:Eclampsia / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: eclampsia; high-risk pregnancy; hypertension; pre-eclampsia; pregnancy; pregnancy complications; prenatal care