Fetal outcome in hypertensive disorders of pregnancy

Abstract

Fetal outcome was evaluated in 157 hypertensive pregnant women whose underlying disease had been established by renal biopsy. Patients had pathologic diagnoses of preeclampsia (95), nephrosclerosis (23), nephrosclerosis with superimposed preeclampsia (13), interstitial and tubular nephorpathy (7) and normal findings (6). Pregnancy outcome in this selected group of patients was extremely poor, with the perinatal mortality rate being 134/1000. There were 21 perinatal deaths; 3/4 of these were stillbirths, and most were encountered below the 5th weight percentile and before 30 wk gestation. Of the infants, 22% were small-for-gestational-ages and 40% were born before term. Most of the perinatal mortality (81%) was in women with preeclampsia. The worst fetal outcome was encountered in multiparous preeclamptic women, > 50% of whom manifested nephrotic-range proteinuria during pregnancy. Despite the presence of hypertension throughout most of their gestation, women with nephrosclerosis alone had the best fetal survival rate.