POST-PARTUM EVALUATION OF RENAL FUNCTION IN PRE-ECLAMPSIA- A PROSPECTIVE STUDY

Abstract

Introduction: Hypertensive disorders complicating pregnancy is the most common complication that occurs in pregnancy. The incidence varies in different populations, different races and is affected by the definitions used. Mostly hypertensive disorders are seen in nulliparous women, teenage pregnancy or elderly women and race.
Materials and methods: This was a prospective study. This study was conducted for 1 year from January 2024 to December 2024. Patients included were those diagnosed to have preeclampsia attending in department of obstetrics and gynecology, Tagore Medical College, Chennai. Blood pressure more than 140/90 mmHg and proteinuria >300 mg/24 hour after 20 weeks of pregnancy was included in this study. After fulfilling the inclusion exclusion criteria 236 patients were taken as study sample. In this observational study 236 women with preeclampsia who were evaluated and managed at Tagore Medical college, Chennai were recruited. An informed consent form was obtained from the subjects. For each eligible participant, authors collected clinical and laboratory data from third trimester of antenatal period (one day before delivery and 6 weeks and three months after delivery). Clinical data include age, BMI, systolic and diastolic blood pressure, pregnancy characteristics (gravidity, parity, gestational age, mode of delivery, gestational age at preeclampsia detected, gestational age of delivery, socioeconomic status, educational status of patient, birth weight and outcome, sex of the baby.
Results: A total of 236 patients were followed up in this 1-year long study. The following variables were studied. A total 94.9% of patients were taking antihypertensives. Maximum number of patients were from the age group of 21-30 years, amounts to 67.8% and mean age was 26. Mean BMI in non-severe preeclampsia was 24.56, severe preeclampsia group was 25.67 which was significant. Mean gestational age at detection of preeclampsia and delivery were 32.6 and 36.1 respectively (Table 1). Mean birth weight was 2.17 kg and on comparing birth weight between non severe preeclampsia and severe preeclampsia group, birth weight was 2.23 and 2.05 respectively which was statistically significant. Majority of patients delivered vaginally (55.9% term deliveries and 27.1% preterm deliveries), 16.9% ended in LSCS. Blood urea levels were normal after post-partumin both groups. By postpartum, creatinine values became normal in both the groups. By postpartum, GFR values became normal in both the groups. In severe preeclampsia group, proteinuria was persisting even after 3 months whereas proteinuria resolved completely in non-severe pre-eclampsia group. Systolic BP came to normal value by 6 weeks postpartum for non-severe preeclampsia group, where as in severe preeclampsia group it took 3 months.
Conclusion: For most of the women, hypertension will resolve within the 1st week after delivery. Hypertension that persists more than 6 weeks postpartum usually represents a pathology not directly associated with pregnancy such as essential hypertension or underlying endocrine, neurological, or renal disease. These women should have their hypertension confirmed with ambulatory monitoring and referred for investigation for a secondary cause for their hypertension. Proteinuria that persists beyond 6-12 weeks postpartum may also warrant further investigation, particularly in early onset preeclampsia, the group of women most likely to have underlying renal disease.