Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Clinical characteristics and sequelae of intrapartum hypertension – a retrospective review (#70)

Theepika Rajkumar 1 , Angela Makris 2 3 , Annemarie Hennessy 1 2
  1. Department of Medicine, Campbelltown Hospital, Campbelltown, NSW, Australia
  2. School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
  3. Renal Medicine, Liverpool Hospital, Liverpool, NSW, Australia

Background: In a significant proportion of women, elevated blood pressure (BP) may first present during delivery. Intrapartum hypertension (IH) is often overlooked as BP during delivery may be affected by pain, analgesic agents and haemodynamic changes. This study sought to define the prevalence of IH in previously normotensive women, identify associated clinical characteristics, and its impact on maternofetal outcomes.

Methods: In this single-centre retrospective cohort study, all available partograms were reviewed over a 1-month period at Campbelltown Hospital. Women with pre-existing hypertensive disorders of pregnancy (HDP) were excluded. IH was defined as systolic BP (SBP) ⩾140 mmHg or diastolic BP (DBP) ⩾90 mmHg during delivery. Baseline characteristics, intrapartum factors, and maternofetal outcomes were collected.

Results: Of 300 partograms, 18 women with pre-existing HDP and 53 partograms without BP measurements were excluded. Amongst 229 deliveries, 91 (39.7%) had IH. Eighty-two women (35.8%) had SBP ⩾140mmHg, 12 (5.2%) had SBP ⩾160mmHg, and 44 (19.2%) had DBP ⩾90mmHg. A higher BMI (p=0.02) and higher booking SBP (p=0.04) were associated with IH. Women who had any labour onset were less likely to have IH (p<0.01). A longer second stage of labour (p=0.03), intrapartum non-steroidal anti-inflammatory medications (p<0.01) and epidural anaesthesia (p<0.01) were associated with IH, while IV syntocin for labour induction was not. Women with IH had a longer inpatient admission following delivery (p<0.01), and elevated postpartum BP (p<0.01) with discharge on regular antihypertensive medications (p=0.01). IH was also associated with APGAR scores <9 at 1 and 5 minutes (p=0.03; p=0.02), neonatal birthweight <10th centile (p<0.01), and need for high-level neonatal care (p=0.02). 

Conclusion: Almost 40% of previously normotensive women developed IH, which was associated with longer maternal admission, elevated postpartum BP, and discharge with regular antihypertensive medications. Fetal outcomes were also poorer, with lower APGAR scores, more neonatal birthweight <10th centile and an increased need for high-level neonatal care.