Characteristic of Pregnant Woman with Hypertension

In Obstetric and Gynecological Department

Hasan Sadikin General Hospital Bandung in 2013
Andre Ruggery Ichwan,1 Rubin S. Gondodiputro,2
Anggraini Widjadjakusuma3
1
Faculty of Medicine, 2Departement of Internal Medicine,
3
Departement of Epidemiology and Biostatistics
Universitas Padjadjaran/ Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
Jalan Raya Bandung-Sumedang Km. 21, Jatinangor-Bandung

1. Andre Ruggery Ichwan

Faculty of Medicine, Universitas Padjadjaran
Jalan Raya Bandung-Sumedang Km.21
Jatinangor-Bandung
Phone : +6281285247252
Email : andreruggery@gmail.com
2. Rubin S. Gondodiputro, dr., SpPD-KGH
Departement of Internal Medicine, Faculty of Medicine, Universitas
Padjadjaran
Jalan Pasteur No.38
Bandung 40161
Phone : +62811228975
Email : r.surachno@yahoo.com
3. Anggraini Widjadjakusuma, dr., SpPD
Departement of Epidemiology and Biostatistics, Faculty of Medicine,
Universitas Padjadjaran
Jalan Prof. Eyckman No.38
Bandung 40161
Phone : +6283821554555
Email : aw.lukmanarini@gmail.com

Characteristic of Pregnant Woman with Hypertension

In Obstetric and Gynecological Department
Hasan Sadikin General Hospital Bandung in 2013
Andre Ruggery Ichwan1, Rubin S. Gondodiputro2, Anggraini
Widjadjakusuma3
1
Faculty of Medicine,2Departement of Internal Medicine
3
Departement of Epidemiology dan Biostatistic
Universitas Padjadjaran/Hasan Sadikin General Hospital Bandung
Abstract
Background: Hypertension can lead to maternal death because of complication
such as heart failure, kidney failure and intracerebral hemorrhage. It is important
to be aware of hypertension in pregnant woman with certain characteristics, in
order to reduce maternal death. This study aimed to identify the characteristics of
pregnant woman with hypertension.
Methods: This descriptive cross-sectional study involves 150 medical record of
pregnant woman with hypertension hospitalized in Obstetrics and Gynecology
Department of Dr. Hasan Sadikin General Hospital Bandung in 2013 selected
using systematic random sampling and characteristics of patient with different
type of hypertension was observed.
Result: Preeclampsia is seen on 37% subject, in which 75% are 18-35 years old,
66% multiparous and 91.1% have no history of hypertension. Only 6% of the
subject are eclampsia, all of them are 18-35 years old, 66% multiparous and
88.9% have no history of hypertension. Gestational hypertension is seen on 27%
of subjects, 72.5% are 18-35 years old and 72.5% are multiparous. Majority of
subject with chronic hypertension (65.4%) are 35 years or older and all are
multiparous. In superimposed preeclampsia there is no difference between both
age group, and 94.7% multiparous. Blood pressure of eclampsia and
superimposed preeclampsia are higher than other types of hypertension.
Conclusion: Preeclampsia and gestational hypertension occurred more often than
other types of hypertension. Almost in all types of hypertension, most subjects are
18-35 years old, multiparous, and blood pressure of eclampsia and superimposed
preeclampsia patients are higher.
Keywords: characteristic, hypertension, pregnancy

Karakteristik Ibu Hamil dengan Hipertensi

Di Departemen Ilmu Kebidanan dan Penyakit Kandungan
RSUP Dr. Hasan Sadikin Bandung
Pada Tahun 2013
Andre Ruggery Ichwan1, Rubin S. Gondodiputro2, Anggraini Widjadjakusuma3
1
Fakultas Kedokteran,2Departemen Ilmu Penyakit Dalam
3
Departemen Epidemiologi dan Biostatistika
Universitas Padjadjaran/RSUP Dr. Hasan Sadikin Bandung
Abstrak
Latar Belakang: Kematian maternal dapat disebabkan oleh komplikasi hipertensi
seperti gagal jantung, gagal ginjal maupun perdarahan intraserebral. Hipertensi
pada ibu hamil dengan karakteristik tertentu penting untuk diwaspadai agar dapat
menurunkan angka kematian ibu. Penelitian ini bertujuan untuk mengidentifikasi
karakteristik ibu hamil dengan hipertensi.
Metode: Studi deskriptif potong lintang ini melibatkan 150 rekam medis ibu
hamil dengan hipertensi yang dirawat di Departemen Ilmu Kebidanan dan
Penyakit Kandungan RSUP Dr. Hasan Sadikin Bandung pada tahun 2013, diambil
secara systematic random sampling.
Hasil: Didapatkan 37% pasien preeklamsia, 75% berusia 18-35 tahun, 66%
multipara, 91.1% tidak ada riwayat hipertensi. Terdapat 6% kasus eklamsia,
semuanya berusia 18-35 tahun, 66% multipara, 88.9% tidak memiliki riwayat
hipertensi. Terdapat 27% pasien hipertensi gestasional, 72.5% berusia 18-35
tahun, 72.5% multipara. Pasien hipertensi kronis 65.4% berusia 35 tahun atau
lebih, seluruhnya multipara. Pada pasien superimposed preeklamsia tidak ada
perbedaan usia yang mencolok, 47.4% berusia 18-35 tahun, 52.6% berusia 35
tahun atau lebih, 94.7% multipara. Tekanan darah pasien eklamsia dan
superimposed preeklamsia lebih tinggi daripada hipertensi lainnya.
Simpulan: Preeklamsia dan hipertensi gestasional lebih banyak terjadi
dibandingkan jenis hipertensi lainnya. Hampir pada seluruh jenis hipertensi,
pasien berusia 18-35 tahun, multipara. Tekanan darah lebih tinggi pada pasien
eklamsia dan superimposed preeklamsia.
Kata Kunci: hipertensi, ibu hamil, karakteristik

Introduction
According to surveillance conducted by WHO, 16% maternal death in the
world was caused by hypertension.1 Especially in Indonesia, hypertension in
pregnancy caused 3,335 maternal death in 2010. 2 The presence of complication
can be one of the reason for the death. Usually, hypertension in pregnancy was
complicated by seizure (eclampsia), heart failure, kidney failure, even
intracerebral hemorrhage.3,4 Patients with hypertension in pregnancy can also
affected by subsequent cardiovascular condition after pregnancy that can lead to
death.5 High number of mortality rate and decent number of possible complication
shows the importance of accurate complication prevention to hypertension in
pregnancy. Good prevention can be done if characteristics of pregnant woman
with hypertension is identified properly. This study aims to identify characteristics
of pregnant woman with hypertension.
Methods
This descriptive cross-sectional study was conducted from August until
October 2014 in Obstetric and Gynecological Department Hasan Sadikin General
Hospital Bandung. Data was taken from medical records of pregnant woman with
hypertension. Medical records was taken from the center Medical Records
section. The use of medical records have been approved by Ethical Health
Research Committee of Hasan Sadikin General Hospital Bandung. Population of
this study was pregnant woman hospitalized in Obstetric and Gynecological
Department Hasan Sadikin General Hospital Bandung.

Criteria for inclusion were pregnant woman with systolic blood pressure
140 mmHg or diastolic blood pressure 90 mmHg, while the criteria for
exclusion were patients with age under 18 or incomplete medical records. Sample
collected with systematic random sampling from 392 pregnant woman with
hypertension and unfortunately only 150 data is eligible for further analysis due to
many missing medical records.
Data taken from medical records include characteristics such as age,
educational level, history of hypertension, history of miscarriage, parity, blood
pressure level, and proteinuria. Characteristic of patient with different type of
hypertension was then observed. Collected data was analyzed using statistic
software and Microsoft Excel, and presented in the form of table.
Results
Preeclampsia is the most common type of hypertension in pregnant
woman (37%), followed by gestational hypertension (27%). Only 6% were
suffering from eclampsia.

Table 1 Types of hypertension in pregnant woman

Types

Amount (n)

Frequency (%)

Preeclampsia
Gestational Hypertension
Chronic Hypertension
Superimposed preeclampsia
Eclampsia

56
40
26
19
9

37%
27%
17%
13%
6%

Total

150

100%

Table 2 showed that of the 56 patients with preeclampsia, 42 patients

(75%) were aged 18-35 years. Distribution of educational level in preeclampsia
patients seem evenly. A total of 37 multiparous patients, 32 of them (57.2%) had a
number of pregnancies two to four. Sixty four percent is classified as hypertension
grade two. Only one patient was negative for proteinuria. Most (87.5%)
preeclampsia patients had no history of abortion. Almost all patients (91.1%) did
not have a prior history of hypertension.

Characteristics

Amount (n=56)

Frequency (%)

42
14

75
25

17
16
18
5

30.4
28.6
32.1
8.9

19
32
5

33.9
57.2
8.9

20
36

35.7
64.3

1
25
16
13
1

1.8
44.6
28.6
23.2
1.8

7
49

12.5
87.5

5
51

8.9
91.1

Age
1835
>35
Education
Elementary
Junior High
Senior High
Bachelor
Parity
Nulipara
Multipara (2-4)
Grande Multipara (5)
Hypertension Grade
Grade 1
Grade 2
Proteinuria
(-)
(+1)
(+2)
(+3)
(+4)
Miscarriage History
Yes
No
History of Hypertension
Yes
No

Table 2 Characteristics of preeclampsia patients

Table 3 shows the characteristics of patients with gestational hypertension.

It appears that from 40 patients, 29 (72.5%) were aged 18-35 years. As many as
45% of the patients education level is junior high school and most (65.5%) were
multiparous with the number of pregnancies two to four. A total of 77.5% patients
classified as grade one hypertension. Almost all patients, (37 patients, 92.5%) had
negative proteinuria. Only one from five patients (20%) had a history of abortion.
None of the patients had a previous history of hypertension.

Table 3 Characteristics of gestational hypertension patients

Characteristics

Amount (n=40)

Frequency (%)

29
11

72.5
27.5

8
18
12
2

20
45
30
5

11
26
3

27.5
65
7.5

31
9

77.5
22.5

37
2
1
-

92.5
5
2.5
-

8
32

20
80

40

100

Age
1835
>35
Education
Elementary
Junior High
Senior High
Bachelor
Parity
Nulipara
Multipara (2-4)
Grande Multipara (5)
Hypertension Grade
Grade 1
Grade 2
Proteinuria
(-)
(+1)
(+2)
(+3)
(+4)
Miscarriage History
Yes
No
History of Hypertension
Yes
No

Table 4 shows that of 26 patients with chronic hypertension, 17 (65.4%)

were older than 35 years. The education of 42.3% patients was elementary school.
All patients had more than one pregnancy, 53.8% multiparous and 46.2% grande

multipara. A total of 73.1% patients were classified as grade two hypertension. All
patients had negative proteinuria. Most of the patients (73.1%) had no history of
miscarriage. All patients had a history of hypertension.

Table 4 Characteristics of chronic hypertension patients

Characteristics

Amount (n=26)

Frequency (%)

9
17

34.6
65.4

11
7
8
-

42.3
26.9
30.8
-

14
12

53.8
46.2

7
19

26.9
73.1

26
-

100
-

7
19

26.9
73.1

26
-

100
-

Age
1835
>35
Education
Elementary
Junior High
Senior High
Bachelor
Parity
Nulipara
Multipara (2-4)
Grande Multipara (5)
Hypertension Grade
Grade 1
Grade 2
Proteinuria
(-)
(+1)
(+2)
(+3)
(+4)
Miscarriage History
Yes
No
History of Hypertension
Yes
No

Table 5 shows that the age of patients with superimposed preeclampsia

was similarly distributed. No tendency of certain educational level in all patients
with superimposed preeclampsia. There were 12 multiparous patients (63.2%) and
6 grande multipara patients (31.6%). Most of the patients (84.2%) were

hypertension grade two. Eleven of 19 patients had negative proteinuria. Most of

the patients (68.4%) had no history of abortion. All patients had a previous history
of hypertension.

Table 5 Characteristics of superimposed preeclampsia patients

Characteristics

Amount (n=19)

Frequency (%)

9
10

47.4
52.6

5
7
7
-

26.3
36.8
36.8
-

1
12
6

5.3
63.2
31.6

3
16

15.8
84.2

11
3
5
-

57.9
15.8
26.3
-

6
13

31.6
68.4

19
-

100
-

Age
1835
>35
Education
Elementary
Junior High
Senior High
Bachelor
Parity
Nulipara
Multipara (2-4)
Grande Multipara (5)
Hypertension Grade
Grade 1
Grade 2
Proteinuria
(-)
(+1)
(+2)
(+3)
(+4)
Miscarriage History
Yes
No
History of Hypertension
Yes
No

Table 6 shows that the all eclampsia patients aged 18-35 years. There was
no particular inclination towards educational level. The majority (66.67%) were
multiparous, all patients classified as hypertension grade two and all patients had
proteinuria (positive 1 or 2) with the amount of each is almost the same. All
eclampsia patients had no history of miscarriage and most (88.9%) did not have a
prior history of hypertension.

10

Table 6 Characteristics of eclampsia patients

Characteristics

Amount (n=9)

Frequency (%)

9
0

100
0

2
3
4
-

22.2
33.3
44.5
-

3
6
-

33.3
66.7
-

100

4
5
-

44.4
55.6
-

100

1
8

11.1
88.9

Age
1835
>35
Education
Elementary
Junior High
Senior High
Bachelor
Parity
Nulipara
Multipara (2-4)
Grande Multipara (5)
Hypertension Grade
Grade 1
Grade 2
Proteinuria
(-)
(+1)
(+2)
(+3)
(+4)
Miscarriage History
Yes
No
History of Hypertension
Yes
No

Discussion
In this study, the most common types of hypertension in pregnant women
was preeclampsia (37%) followed by gestational hypertension (27%), chronic
hypertension (17%), superimposed preeclampsia (13%) and only 6% were
suffering

from

eclampsia.

Percentage

of

gestational

hypertension

and

preeclampsia in this study were similar compared to studies conducted by Roberts

et al. which stated that 9.8% of the study subjects had hypertension in pregnancy,
4.3% had gestational hypertension and 4.2% had pre-eclampsia.6
Most of preeclampsia patients aged 18-35 years (75%), 87.5% had no
history of abortion and all of them had no history of hypertension (91.1%). This
result was similar with the research conducted by Poon et al. which stated that the
average age of patients with preeclampsia was approximately 31-32 years. 7 In this
11

study, most patients were multiparous (57.2%), that was known to be a risk factor
for preeclampsia according to a study conducted by Papageorghiou et al. 8
However, studies conducted by Roberts6 et al., Saftlas9 et al. and Duckitt10 et al.
revealed that nulliparous was also a risk factor for preeclampsia. A total of 36
from 56 patients (64.3%) were classified as hypertension grade two. Most
preeclampsia patients did not have a history of abortion. According to a study
conducted by Trogstad11 et al. and North12 et al., spontaneous or induced abortion,
have a protective effect against pre-eclampsia
Most of gestational hypertension patients aged 18-35 years (72.5%), it is
similar to a study conducted by Poon et al. who earn an average of gestational
hypertension patients aged 33 years.7 Two patients were excluded because the age
was under 18. Most patients (65%) were multiparous and 80% did not have a
history of abortion. These findings differ from research conducted by Poon et al.
which stated that nulliparous was a risk factor for gestational hypertension.7 Most
gestational hypertension patients (77.5%) was classified as hypertension grade 1.
There were 5% of patients with proteinuria (+1) and 2.5% proteinuria (+2). This
may be due to other diseases that already existed but cannot be known because
there was no information in the medical record.
In patients with chronic hypertension, 65.4% were over 35 years old, all
multiparous and most did not have a history of miscarriage (73.1%). Most patients
(73.1%) classified as hypertension grade two and all proteinuria test results were
negative.
The age distribution of superimposed preeclampsia patients was similar
for 1835 years of age (47.4%) and 35 years older (52.6%). Patients were likely to

12

be multiparous (63.2%) and had no history of miscarriage (68.4%). Most patients

(84.2%) classified as hypertension grade two. A total of 57.9% of patients had
negative proteinuria.
All of eclampsia patients aged 18-35 years, 66% multiparous, none had a
history of miscarriage and 88.9% had no prior history of hypertension. This result
was in contrast to a study conducted by Liu et al. 13 who showed that many
eclampsia occured in nulliparous women. All eclampsia patients classified as
hypertension grade two and all had proteinuria.
Preeclampsia and gestational hypertension occured more frequently than
other types of hypertension in pregnant women. This study found that the
characteristics of pregnant women with hypertension were mostly 18-35 years
old, multiparous and had no history of miscarriage. In pregnant women with age
more than 35 years, most had a history of hypertension. Although did not have a
previous history of hypertension, patients could be exposed to preeclampsia and
eclampsia. In addition, patients with eclampsia and superimposed preeclampsia
tends to have higher blood pressure than patients with other type of hypertension
in pregnancy.
Limitations of this study were that some of the medical record were
missing and incomplete. Further study is needed to know the relationship between
the characteristics of pregnant women with the risk of developing hypertension in
pregnancy. The results of this study are expected to be useful in increasing public
awareness and health workers against hypertension in pregnant women, especially
in patients under 35 years old and multiparous. In addition, patients without a

13

history of miscarriage or hypertension remains to be observed because they were

still having a possibility for developing hypertension in pregnancy.

14

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